Flight Paramedic Certification (FP-C) — Questions and Answers

Question 1: Which end-point best indicates adequate resuscitation has been achieved in a septic shock patient during transport?

Reduction in heart rate below 80 bpm
Normalization of systolic BP to ≥120 mmHg
Lactate clearance ≥10% and urine output ≥0.5 mL/kg/hr (Correct answer)
Central venous pressure of 8-12 mmHg

Correct answer: Lactate clearance ≥10% and urine output ≥0.5 mL/kg/hr

Lactate clearance of at least 10% combined with adequate urine output indicates improved tissue perfusion and is a validated resuscitation endpoint in sepsis.

Question 2: A 32-week pregnant patient presents with painless bright-red vaginal bleeding. Which condition should the flight paramedic suspect first?

Placenta previa (Correct answer)
Ectopic pregnancy
Placental abruption
Uterine rupture

Correct answer: Placenta previa

Placenta previa classically presents with painless bright-red vaginal bleeding in the second or third trimester.

Question 3: In neurogenic shock following spinal cord injury, which hemodynamic combination is expected?

Hypotension with tachycardia
Hypertension with bradycardia
Hypertension with tachycardia
Hypotension with bradycardia (Correct answer)

Correct answer: Hypotension with bradycardia

Neurogenic shock presents with hypotension and paradoxical bradycardia due to loss of sympathetic tone below the injury level with intact vagal activity.

Question 4: What is the first step in managing a patient with a penetrating chest injury and suspected tension pneumothorax?

Performing needle decompression to relieve the pressure (Correct answer)
Positioning the patient in a sitting position
Administering pain relief and oxygen
Applying a chest seal and monitoring for signs of shock

Correct answer: Performing needle decompression to relieve the pressure

A tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, compressing the lung and shifting mediastinal structures, leading to circulatory collapse. Performing needle decompression is the immediate, definitive intervention to relieve this trapped pressure, allowing the lung to re-expand and restoring cardiovascular function.

Question 5: Auto-PEEP (intrinsic PEEP) in a mechanically ventilated patient is best described as:

A deliberate PEEP increase to improve oxygenation
The difference between set PEEP and measured airway pressure
High plateau pressure caused by low compliance
Air trapping due to incomplete exhalation before the next breath (Correct answer)

Correct answer: Air trapping due to incomplete exhalation before the next breath

Auto-PEEP results from air trapping when expiratory time is insufficient for complete exhalation, increasing baseline alveolar pressure.

Question 6: In volume-control ventilation, if the patient's lung compliance decreases, which parameter will change?

PEEP
Tidal volume
Respiratory rate
Peak inspiratory pressure (Correct answer)

Correct answer: Peak inspiratory pressure

In volume-control mode, the ventilator delivers the set tidal volume regardless of compliance, so decreased compliance manifests as increased peak inspiratory pressure.

Question 7: Which lab value is the most sensitive indicator of inadequate tissue perfusion and guides resuscitation efficacy in shock?

Central venous oxygen saturation
Serum pH
Base excess
Serum lactate (Correct answer)

Correct answer: Serum lactate

Serum lactate is the most sensitive and widely used marker of tissue hypoperfusion; elevated levels indicate anaerobic metabolism from inadequate oxygen delivery.

Question 8: What is the initial drug of choice for eclamptic seizures in the prehospital setting?

Diazepam 10 mg IV push
Lorazepam 4 mg IV
Phenytoin 1 g IV
Magnesium sulfate 4-6 g IV over 15-20 minutes (Correct answer)

Correct answer: Magnesium sulfate 4-6 g IV over 15-20 minutes

Magnesium sulfate is the definitive treatment for eclamptic seizures, with a loading dose of 4-6 g IV over 15-20 minutes followed by maintenance infusion.

Question 9: A flight paramedic is managing a patient in status epilepticus who has been seizing for over 10 minutes. IV access is not yet established. According to current guidelines, what is the most appropriate initial intervention?

Prepare for rapid sequence intubation immediately
Administer 10 mg midazolam intramuscularly (Correct answer)
Administer 1 g levetiracetam via an intraosseous line
Administer 4 mg lorazepam intravenously

Correct answer: Administer 10 mg midazolam intramuscularly

For prehospital management of status epilepticus without established IV access, the American Epilepsy Society guidelines recommend the administration of 10 mg of midazolam via the intramuscular route. [22, 24, 25] This allows for rapid drug administration and absorption to terminate seizure activity, which is the primary goal. Intramuscular midazolam has been shown to be as effective as intravenous lorazepam in this setting. [28]

Question 10: Which of the following physiological stressors of flight is responsible for causing dehydration, drying of mucous membranes, and potentially thickening respiratory secretions?

Noise
Vibration
Decreased Humidity (Correct answer)
Gravitational Forces

Correct answer: Decreased Humidity

The air at higher altitudes is significantly less humid. Aircraft cabin air is often very dry, which increases the rate of evaporation from a patient's skin and respiratory tract. This leads to dehydration, drying of mucous membranes, and can cause respiratory secretions to become thicker and more difficult to clear, posing a risk for patients with respiratory conditions.

Question 11: According to FAA Part 135 regulations, the "sterile cockpit" rule must be maintained during which phases of flight?

Any time the pilot-in-command deems it necessary for safety.
During all critical phases of flight, including taxi, takeoff, landing, and all operations below 10,000 feet except cruise flight. (Correct answer)
Only during takeoff and landing.
Throughout the entire duration of the patient transport flight.

Correct answer: During all critical phases of flight, including taxi, takeoff, landing, and all operations below 10,000 feet except cruise flight.

The sterile cockpit rule, mandated by FAA regulations FAR 121.542 and 135.100, prohibits non-essential conversations and activities during critical phases of flight. These phases are defined as taxi, takeoff, landing, and all other flight operations conducted below 10,000 feet, excluding cruise flight. This rule is designed to minimize distractions and allow the flight crew to focus on essential operational tasks.

Question 12: A term neonate is delivered through thick, particulate meconium-stained amniotic fluid. The infant is limp, has a heart rate of 80 bpm, and is making no respiratory effort. According to the most recent Neonatal Resuscitation Program (NRP) guidelines, what is the appropriate first step AFTER initial warming, drying, and stimulation?

Immediately intubate and perform tracheal suction to remove meconium.
Initiate positive-pressure ventilation (PPV) with a bag-mask device. (Correct answer)
Provide free-flow oxygen and reassess in 30 seconds.
Insert an orogastric tube to decompress the stomach.

Correct answer: Initiate positive-pressure ventilation (PPV) with a bag-mask device.

Current NRP guidelines no longer recommend routine intubation and tracheal suctioning for non-vigorous infants born through meconium-stained fluid. The priority is to establish effective ventilation. After the initial steps (warming, drying, positioning, clearing the mouth/nose if needed, and stimulation), if the infant is apneic or has a heart rate below 100 bpm, positive-pressure ventilation should be initiated immediately.

Question 13: What I:E ratio is typically used as a starting point for most mechanically ventilated adults?

1:3
1:1
2:1
1:2 (Correct answer)

Correct answer: 1:2

A 1:2 I:E ratio (inspiration half the length of expiration) is the standard starting point, allowing adequate exhalation time.

Question 14: What is the mechanism of action for midazolam when used for sedation in trauma patients?

Potentiates GABA neurotransmission (Correct answer)
Inhibits acetylcholine release
Blocks beta-adrenergic receptors
Antagonizes NMDA receptors

Correct answer: Potentiates GABA neurotransmission

Midazolam is a benzodiazepine that exerts its sedative and anxiolytic effects by potentiating the activity of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the central nervous system. By enhancing GABA's effects, it increases chloride ion influx into neurons, leading to hyperpolarization and reduced neuronal excitability.

Question 15: A trauma patient with suspected hemorrhagic shock is unresponsive to 2L of crystalloid. What resuscitation strategy is preferred in modern flight medicine?

Colloid infusion with albumin
Continue crystalloid at 500 mL boluses
1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (Correct answer)
Vasopressor initiation with norepinephrine

Correct answer: 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets

Damage control resuscitation using a 1:1:1 ratio of pRBC:FFP:platelets is the evidence-based approach for hemorrhagic shock to restore coagulation factors alongside volume.

Question 16: During transport, a ventilated patient's SpO2 drops to 88%. The FiO2 is 0.60 and PEEP is 5 cmH2O. What is the most appropriate initial intervention?

Switch from volume control to pressure control
Decrease tidal volume to 4 mL/kg
Increase respiratory rate to 20
Increase PEEP to 8-10 cmH2O (Correct answer)

Correct answer: Increase PEEP to 8-10 cmH2O

Increasing PEEP recruits collapsed alveoli and improves oxygenation when FiO2 escalation alone is insufficient.

Question 17: During neonatal resuscitation of a newborn delivered in-flight, if heart rate remains below 60 bpm after 30 seconds of positive pressure ventilation, what is the next intervention?

Administer epinephrine
Intubate immediately
Begin chest compressions at 3:1 ratio with ventilation (Correct answer)
Increase oxygen flow

Correct answer: Begin chest compressions at 3:1 ratio with ventilation

If HR remains <60 bpm after adequate positive pressure ventilation, chest compressions should be initiated at a 3:1 compression-to-ventilation ratio.

Question 18: What is the first-line treatment for a patient experiencing status epilepticus in a pre-hospital setting?

Phenytoin
Lorazepam (Correct answer)
Levetiracetam
Phenobarbital

Correct answer: Lorazepam

Lorazepam, a benzodiazepine, is the first-line treatment for status epilepticus in the pre-hospital setting due to its rapid onset of action and high efficacy in terminating prolonged seizures. It works by enhancing the inhibitory effects of GABA in the brain, thereby suppressing abnormal neuronal activity.

Question 19: A 100 kg adult male has 30% TBSA full-thickness burns. Using the Parkland formula (4 mL/kg/%TBSA), what is the correct IV fluid rate (Lactated Ringer's) for the first 8 hours, calculated from the time of the burn?

1000 mL/hr
1500 mL/hr
500 mL/hr
750 mL/hr (Correct answer)

Correct answer: 750 mL/hr

The Parkland formula is calculated as: 4 mL x body weight (kg) x %TBSA. In this case: 4 mL x 100 kg x 30% = 12,000 mL over 24 hours. Half of this total volume (6,000 mL) must be administered in the first 8 hours from the time of injury. Therefore, the hourly rate for the first 8 hours is 6,000 mL / 8 hours = 750 mL/hr.

Question 20: When performing endotracheal intubation on a 1-year-old child, the flight paramedic should be aware that the narrowest portion of the pediatric airway is at the level of the:

Cricoid cartilage (Correct answer)
Tracheal rings
Epiglottis
Vocal cords

Correct answer: Cricoid cartilage

A key anatomical difference between pediatric and adult airways is the location of the narrowest point. In adults, the narrowest part is the glottic opening (vocal cords). In infants and young children, the airway is funnel-shaped, and the narrowest point is the cricoid cartilage, which is a complete, non-expandable ring.

Question 21: A flight request is received for an interfacility transport. The current weather at the departure base and the receiving facility is above the minimums required by the company's operational specifications. However, the pilot-in-command (PIC) declines the flight due to concerns about a rapidly developing weather system between the two locations. This decision is an example of:

Medical necessity overriding aviation safety rules.
Poor crew resource management.
A violation of FAA Part 135 regulations.
The PIC's ultimate authority and responsibility for the safety of the flight. (Correct answer)

Correct answer: The PIC's ultimate authority and responsibility for the safety of the flight.

The Pilot-in-Command (PIC) has the final authority and direct responsibility for the operation and safety of a flight under FAA Part 135 regulations. Even if the reported weather meets legal minimums, the PIC can and should refuse any flight they believe cannot be completed safely. This is a fundamental principle of aviation safety and demonstrates good judgment, not a violation or poor CRM.

Question 22: When performing resuscitative thoracotomy in the field for traumatic arrest, which patient has the best chance of neurologically intact survival?

Penetrating abdominal trauma with no vital signs for 30 minutes
Penetrating thoracic trauma with witnessed loss of vital signs within 15 minutes (Correct answer)
Blunt trauma with asystole on scene arrival
Blunt trauma with 10-minute downtime and PEA

Correct answer: Penetrating thoracic trauma with witnessed loss of vital signs within 15 minutes

EDT has the highest survival for penetrating thoracic wounds with witnessed cardiac arrest or vital signs lost within 15 minutes of arrival.

Question 23: A flight paramedic is preparing to transport a patient with an endotracheal tube in a fixed-wing aircraft for a long-distance flight. To mitigate the effects of Boyle's Law on the ET tube cuff, the most appropriate action is to:

Inflate the cuff with the maximum recommended volume of air before takeoff.
Continuously monitor the cuff pressure with a manometer and adjust as needed. (Correct answer)
Deflate the cuff completely during ascent and reinflate it at cruising altitude.
Inflate the cuff with sterile saline instead of air.

Correct answer: Continuously monitor the cuff pressure with a manometer and adjust as needed.

While inflating the cuff with saline is a technique used, the most universally correct and safest answer is to continuously monitor the cuff pressure with a manometer. As the aircraft ascends, the air in the cuff will expand due to Boyle's law, potentially causing excessive pressure on the tracheal wall and leading to tissue necrosis. Conversely, during descent, the cuff volume will decrease, which could lead to an air leak and inadequate ventilation. Continuous monitoring and adjustment ensure the cuff pressure remains within the safe and effective range (typically 20-30 cm H2O).

Question 24: What is the first step in assessing a trauma patient in a pre-hospital setting?

Obtain a detailed medical history
Assess the patient's airway, breathing, and circulation (ABCs) (Correct answer)
Check the patient's blood pressure
Perform a head-to-toe assessment

Correct answer: Assess the patient's airway, breathing, and circulation (ABCs)

The first step in assessing any trauma patient in a pre-hospital setting is to systematically evaluate and manage their Airway, Breathing, and Circulation (ABCs). This primary survey prioritizes identifying and addressing immediate life-threatening conditions to ensure the patient's basic physiological needs are met before proceeding with further assessment.

Question 25: A flight crew is responding to a night scene call for a motor vehicle collision. The ground crew describes a potential landing zone (LZ). Which of the following features described by the ground crew would be an immediate "no-go" for the landing?

Unidentified, unmarked power lines on one side. (Correct answer)
A single tree 150 feet from the edge of the proposed 100x100 ft zone.
The presence of tall grass.
A 5-degree slope.

Correct answer: Unidentified, unmarked power lines on one side.

Wires and unseen obstacles are one of the greatest dangers to helicopter operations, particularly during night landings at unprepared sites. A 5-degree slope is generally acceptable, tall grass can be managed, and a tree 150 feet away is outside the safety zone. Unseen wires present an unacceptable risk of a catastrophic accident.

Question 26: A flight paramedic is managing a 68-year-old male with severe COPD exacerbation. Despite aggressive bronchodilator therapy and BiPAP, the patient's mental status is declining, and his capnography waveform shows a pronounced 'shark-fin' appearance. What is the most likely indication for this waveform morphology?

Rebreathing of CO2
Esophageal intubation
Hypoventilation
Bronchospasm (Correct answer)

Correct answer: Bronchospasm

The 'shark-fin' capnography waveform is a classic indicator of bronchospasm. The sloped, prolonged expiratory upstroke (Phase II) and a delayed alveolar plateau (Phase III) signify an obstruction to expiratory airflow, which is characteristic of conditions like asthma and COPD.

Question 27: A 65-year-old patient presents with sudden onset of chest pain, shortness of breath, and diaphoresis. <br>Which of the following conditions is most likely?

Myocardial infarction (Correct answer)
Aortic dissection
Tension pneumothorax
Pulmonary embolism

Correct answer: Myocardial infarction

The sudden onset of chest pain, shortness of breath, and diaphoresis (sweating) in an older adult are classic and highly concerning symptoms indicative of a myocardial infarction (heart attack). These symptoms arise from a blockage in the coronary arteries, leading to ischemia and damage to the heart muscle.

Question 28: Which of the following is the most definitive clinical sign indicating the need for early endotracheal intubation in a patient rescued from an enclosed space fire?

Singed nasal hairs and facial burns.
Progressive hoarseness and stridor. (Correct answer)
SpO2 of 92% on a non-rebreather mask.
Carbonaceous sputum.

Correct answer: Progressive hoarseness and stridor.

Progressive hoarseness and stridor are ominous signs of significant upper airway edema and impending airway obstruction. This finding warrants immediate and definitive airway management. While singed nasal hairs, facial burns, and carbonaceous sputum are all indicators of potential inhalation injury, they do not, in isolation, mandate intubation and can be managed with close observation. A slightly low SpO2 can be due to various factors and can often be corrected with high-flow oxygen, but stridor indicates a critical airway narrowing that is unlikely to resolve without intervention.

Question 29: A 3-year-old child has a complete upper airway obstruction from a foreign body that cannot be dislodged with basic life support maneuvers. Orotracheal intubation is unsuccessful due to the obstruction. What is the most appropriate next step in managing this patient's airway?

Place a laryngeal mask airway (LMA)
Perform a needle cricothyrotomy (Correct answer)
Attempt a retrograde intubation
Perform a surgical cricothyrotomy

Correct answer: Perform a needle cricothyrotomy

Surgical cricothyrotomy is generally contraindicated in young children (typically under the age of 10-12) due to the anatomical differences in the pediatric airway, such as a smaller cricothyroid membrane and a more funnel-shaped larynx. In a 'cannot intubate, cannot ventilate' scenario in a pediatric patient, a needle cricothyrotomy is the indicated emergency procedure to provide temporary oxygenation.

Question 30: Which of the following statements best exemplifies the use of a key Crew Resource Management (CRM) principle during a critical phase of patient care in flight?

"Pilot, how much longer until we land? I need to know for my charting."
"I've done this a hundred times, I don't need the checklist for this procedure."
"That blood pressure seems low. Can we double-check the cuff size and placement before giving another vasodilator?" (Correct answer)
"I'm the lead paramedic, so we will be using my preferred drug dosage for this intubation."

Correct answer: "That blood pressure seems low. Can we double-check the cuff size and placement before giving another vasodilator?"

Effective CRM involves using all available resources, including personnel, to promote safety and reduce errors by encouraging open communication, situational awareness, and teamwork. The statement in option A demonstrates cross-monitoring, inquiry, and advocacy by respectfully questioning a finding and suggesting a verification step. The other options demonstrate poor CRM, such as distracting the pilot, hierarchical decision-making, and overconfidence.

Question 31: During transport of a pregnant patient in active labor, the umbilical cord prolapses. What is the MOST important initial intervention?

Manually elevate the presenting part off the cord and maintain throughout transport (Correct answer)
Place patient in Trendelenburg and apply cold saline-soaked gauze to cord
Immediate oxygen administration only
Attempt to push the cord back into the uterus

Correct answer: Manually elevate the presenting part off the cord and maintain throughout transport

Manually elevating the presenting fetal part off the prolapsed cord prevents compression and preserves umbilical blood flow until emergency delivery.

Question 32: A patient with a pneumothorax is being transported by helicopter. As the aircraft ascends, the flight paramedic should be most concerned about which of the following gas laws causing a potential life-threatening emergency?

Charles's Law
Henry's Law
Dalton's Law
Boyle's Law (Correct answer)

Correct answer: Boyle's Law

Boyle's Law states that the volume of a gas is inversely proportional to the pressure. As the helicopter ascends, the atmospheric pressure decreases, causing the trapped air in the patient's pleural space to expand. This expansion can convert a simple pneumothorax into a tension pneumothorax, which is a life-threatening emergency.

Question 33: A flight paramedic is managing a 55-year-old female who is 12 hours post-ROSC from a V-Fib arrest. She remains comatose. According to current AHA/ERC guidelines for targeted temperature management (TTM), which of the following is the most appropriate intervention?

Administer prophylactic antibiotics and begin cooling to 34°C for 48 hours.
Allow passive rewarming as long as the patient's temperature remains below 38°C.
Maintain a constant core temperature between 32°C and 36°C for at least 24 hours. (Correct answer)
Rapidly cool the patient to 30°C to maximize neuroprotection.

Correct answer: Maintain a constant core temperature between 32°C and 36°C for at least 24 hours.

Current guidelines from major organizations like the American Heart Association (AHA) and European Resuscitation Council (ERC) recommend targeted temperature management (TTM) for comatose patients after cardiac arrest. The goal is to maintain a constant core body temperature between 32°C and 36°C for at least 24 hours to improve neurological outcomes. Cooling below 32°C (mild hypothermia) is not recommended as it can lead to cardiac instability. Simply preventing fever without active temperature control is insufficient, and a 48-hour duration is not the standard initial recommendation.

Question 34: A flight crew is transporting a neonate with a diagnosis of Persistent Pulmonary Hypertension of the Newborn (PPHN). A primary goal of management during transport is to avoid which of the following triggers that can worsen pulmonary vasoconstriction?

Hyperoxia
Normotension
Hypothermia (Correct answer)
Alkalosis

Correct answer: Hypothermia

In PPHN, the pulmonary vasculature is highly reactive. Stimuli such as hypoxia, acidosis, and hypothermia can trigger intense pulmonary vasoconstriction, worsening the right-to-left shunting and hypoxemia. Maintaining normothermia is a critical component of care to prevent this adverse reaction. While severe hyperoxia and alkalosis are also avoided, hypothermia is a potent and preventable vasoconstrictive trigger.

Question 35: A patient in hypovolemic shock has a systolic BP of 70 mmHg and is not responding to initial fluid resuscitation. What permissive hypotension target is acceptable in penetrating trauma without TBI?

Systolic BP 100-110 mmHg
Systolic BP 60-70 mmHg
Systolic BP 80-90 mmHg (Correct answer)
MAP 65-70 mmHg

Correct answer: Systolic BP 80-90 mmHg

Permissive hypotension targeting a systolic BP of 80-90 mmHg reduces ongoing hemorrhage and dilutional coagulopathy in penetrating trauma without TBI.

Question 36: A patient in cardiogenic shock has cool extremities, pulmonary edema, and a BP of 78/50 mmHg. Which combination of interventions is most appropriate?

Aggressive fluid resuscitation with 2L NS
High-dose beta-blocker to reduce myocardial work
Vasopressor support, judicious fluid bolus if hypovolemic component, and consider inotrope (Correct answer)
Nitrates to reduce preload

Correct answer: Vasopressor support, judicious fluid bolus if hypovolemic component, and consider inotrope

Cardiogenic shock management centers on vasopressors (norepinephrine or dopamine) to restore perfusion pressure, with inotropes (dobutamine) to improve cardiac output, while avoiding excessive fluid.

Question 37: Which type of fracture is most likely to cause significant blood loss in a trauma patient?

Rib fracture
Femur fracture (Correct answer)
Clavicle fracture
Wrist fracture

Correct answer: Femur fracture

The femur is the largest and strongest bone in the body, surrounded by significant muscle mass and large blood vessels. A fracture of the femur can lead to substantial internal bleeding, often 1-2 liters or more into the thigh compartment, which can quickly cause hypovolemic shock in a trauma patient.

Question 38: A 2-year-old is being transported for severe croup. The child has significant inspiratory stridor at rest, marked subcostal retractions, and is becoming agitated. Which of the following interventions is the most appropriate initial treatment?

Administer nebulized albuterol to address bronchoconstriction.
Prepare for immediate rapid sequence intubation with a smaller ETT.
Administer high-flow oxygen via a non-rebreather mask and monitor.
Administer nebulized epinephrine and corticosteroids. (Correct answer)

Correct answer: Administer nebulized epinephrine and corticosteroids.

For a child with moderate to severe croup, characterized by stridor at rest and significant work of breathing, the primary treatment is nebulized epinephrine and corticosteroids. Nebulized epinephrine provides rapid vasoconstriction of the upper airway mucosa, reducing edema and relieving the obstruction, while corticosteroids (like dexamethasone) reduce inflammation over a longer period.

Question 39: Which type of shock is MOST likely in a patient with a history of recent myocardial infarction who now presents with respiratory distress, bilateral crackles, S3 gallop, and hypotension?

Hypovolemic shock
Obstructive shock
Cardiogenic shock (Correct answer)
Distributive shock

Correct answer: Cardiogenic shock

Post-MI presentation with pulmonary edema, S3 gallop, and hypotension is classic for cardiogenic shock from left ventricular pump failure.

Question 40: A patient with severe asthma is intubated and mechanically ventilated. SpO2 is 94% but bilateral breath sounds are absent. Ventilator shows high peak pressures. The FIRST action should be:

Increase PEEP to recruit alveoli
Administer IV furosemide for pulmonary edema
Disconnect from the ventilator and manually bag slowly (Correct answer)
Increase FiO2 to 1.0

Correct answer: Disconnect from the ventilator and manually bag slowly

Severe auto-PEEP causing tension physiology requires immediate disconnection to allow passive exhalation and decompress trapped air.

Question 41: When transporting a patient with suspected placental abruption, which finding MOST suggests fetal compromise?

Dark vaginal bleeding
Fetal bradycardia below 100 bpm (Correct answer)
Maternal tachycardia of 110 bpm
Rigid abdomen

Correct answer: Fetal bradycardia below 100 bpm

Fetal bradycardia below 100 bpm is a direct indicator of fetal distress and signals compromised uteroplacental perfusion.

Question 42: When assessing a patient's level of consciousness, which tool is most commonly used?

Glascow Coma Scale (GCS) (Correct answer)
APGAR Score
AVPU Scale
SAMPLE History

Correct answer: Glascow Coma Scale (GCS)

The Glasgow Coma Scale (GCS) is a widely recognized and standardized neurological assessment tool used to objectively measure a patient's level of consciousness. It evaluates three components: eye opening, verbal response, and motor response, providing a quantitative score that helps track changes in neurological status.

Question 43: A hypotensive patient is diagnosed with tension pneumothorax. After needle decompression, the pressure is relieved but hypotension persists. What is the most likely explanation?

Improper needle placement
Bilateral tension pneumothorax
Pericardial tamponade
Concurrent hemorrhagic shock from associated injuries (Correct answer)

Correct answer: Concurrent hemorrhagic shock from associated injuries

Persistent hypotension after successful tension pneumothorax decompression should prompt evaluation for concurrent hemorrhage or other causes of obstructive/hypovolemic shock.

Question 44: What does the "P" in the OPQRST mnemonic stand for when assessing a patient's pain?

Palpation of pain
Provocation/Palliation (Correct answer)
Position of pain
Paresthesia

Correct answer: Provocation/Palliation

In the OPQRST mnemonic, used for detailed pain assessment, the 'P' stands for Provocation/Palliation. This component helps determine what factors make the patient's pain worse (provocation) or better (palliation), providing critical clues about the nature and potential causes of their discomfort.

Question 45: Which medication is typically used as a first-line treatment for anaphylaxis in the pre-hospital setting?

Epinephrine (Correct answer)
Diphenhydramine
Methylprednisolone
Albuterol

Correct answer: Epinephrine

Epinephrine is the first-line treatment for anaphylaxis because it addresses all the life-threatening aspects of the reaction. It acts as a vasoconstrictor to raise blood pressure, a bronchodilator to improve breathing, and reduces swelling, effectively reversing the severe systemic allergic response.

Question 46: Which magnesium sulfate finding during eclampsia management should prompt the flight paramedic to stop the infusion immediately?

Loss of deep tendon reflexes (Correct answer)
Urinary output of 35 mL/hr
Blood pressure drop of 10 mmHg
Respiratory rate of 14 breaths/min

Correct answer: Loss of deep tendon reflexes

Loss of deep tendon reflexes is an early sign of magnesium toxicity and warrants stopping the infusion before respiratory arrest occurs.

Question 47: During the transport of a patient with extensive burns and associated trauma, which of the following is the primary goal of fluid resuscitation?

To decrease the hematocrit to below 40%.
To normalize the patient's blood pressure to 120/80 mmHg.
To maintain end-organ perfusion, evidenced by adequate urine output. (Correct answer)
To replace the total calculated fluid deficit within 12 hours.

Correct answer: To maintain end-organ perfusion, evidenced by adequate urine output.

The primary goal of fluid resuscitation in burn and trauma patients is to maintain adequate end-organ perfusion without causing complications from fluid overload. The single best clinical indicator of adequate resuscitation is urine output (typically targeted at 0.5-1 mL/kg/hr for adults). While blood pressure is monitored, aiming for a specific number like 120/80 mmHg is not the primary goal; permissive hypotension may be acceptable in trauma, and mean arterial pressure (MAP) is often a better target. The fluid deficit is replaced over 24 hours, not 12. Hematocrit is not a primary endpoint for titrating fluid therapy.

Question 48: A flight paramedic is managing a 28-week pregnant patient in cardiac arrest. How long should standard ACLS be attempted before performing perimortem cesarean delivery?

10 minutes
4 minutes (Correct answer)
15 minutes
20 minutes

Correct answer: 4 minutes

Perimortem cesarean delivery should be performed at 4 minutes of resuscitation, targeting delivery by 5 minutes to improve maternal and fetal outcomes.

Question 49: A patient in cardiogenic shock is being managed with an IABP. The flight paramedic observes the arterial waveform and notes that balloon inflation occurs well after the dicrotic notch, and the peak of diastolic augmentation is lower than the patient's own systolic pressure. This timing error is best described as:

Late inflation (Correct answer)
Early deflation
Early inflation
Late deflation

Correct answer: Late inflation

Proper IABP timing involves inflating the balloon at the dicrotic notch, which signifies the closure of the aortic valve. When inflation occurs well after the dicrotic notch, it is termed 'late inflation'. This error results in suboptimal diastolic augmentation, leading to reduced coronary artery perfusion and a less effective increase in myocardial oxygen supply. Early inflation would occur before the dicrotic notch, and deflation errors (early or late) relate to the timing of balloon deflation relative to the start of the next systole.

Question 50: While on a VFR flight, the helicopter unexpectedly enters a dense fog bank, and the pilot announces, "We are IIMC" (Inadvertent Instrument Meteorological Conditions). What is the immediate priority for the medical crew?

Communicate trust in the pilot, limit conversation, and prepare for unusual attitudes. (Correct answer)
Activate the emergency locator transmitter (ELT) in anticipation of a crash.
Contact the receiving hospital to update them on a potential delay.
Immediately begin looking for a hole in the fog to descend through.

Correct answer: Communicate trust in the pilot, limit conversation, and prepare for unusual attitudes.

In an IIMC encounter, the pilot must immediately transition from visual flying to instrument flying. The medical crew's primary responsibility is to cease all non-essential activities, minimize conversation to avoid distracting the pilot, secure the patient and equipment, and trust the pilot's training to safely fly out of the condition. Attempting to find a visual path or performing non-essential communications can increase risk.

Question 51: Which of the following is an absolute contraindication for performing a surgical cricothyrotomy in an adult patient?

Massive maxillofacial trauma preventing intubation
Inability to ventilate with a BVM after failed intubation
Severe laryngeal edema from anaphylaxis
Transection of the trachea with retraction of the distal end (Correct answer)

Correct answer: Transection of the trachea with retraction of the distal end

While most situations in a 'cannot intubate, cannot ventilate' scenario are indications for a cricothyrotomy, transection of the trachea with retraction of the distal segment into the mediastinum is a contraindication. In this case, an incision at the cricothyroid membrane would not access the distal, patent portion of the airway.

Question 52: Which component of the Pediatric Assessment Triangle (PAT) is the most reliable single indicator of the adequacy of ventilation and oxygenation?

Work of Breathing (Correct answer)
Appearance
Circulation to Skin
Capillary Refill

Correct answer: Work of Breathing

The PAT consists of Appearance, Work of Breathing, and Circulation to Skin. While all three are crucial, 'Work of Breathing' is the most direct indicator of respiratory status. It reflects the effort the child is expending to maintain adequate ventilation and oxygenation. Abnormal findings include retractions, nasal flaring, and abnormal airway sounds, which point directly to a respiratory problem.

Question 53: The primary purpose of PEEP in mechanical ventilation is to:

Decrease mean airway pressure
Prevent alveolar collapse at end expiration (Correct answer)
Reduce respiratory rate requirements
Increase tidal volume delivery

Correct answer: Prevent alveolar collapse at end expiration

PEEP maintains positive end-expiratory pressure to prevent alveolar derecruitment and improve oxygenation.

Question 54: A gravid trauma patient has an estimated 30% blood loss. Which assessment finding is MOST concerning for fetal compromise even before obvious maternal deterioration?

Uterine tenderness on palpation
Systolic BP of 95 mmHg
Maternal HR of 105 bpm
Decreased fetal movement reported by the mother (Correct answer)

Correct answer: Decreased fetal movement reported by the mother

The fetus can experience significant compromise before maternal vital signs become overtly abnormal due to uteroplacental redistribution of blood flow.

Question 55: You are preparing for a Rapid Sequence Intubation (RSI) of a 45-year-old male with a traumatic brain injury and a GCS of 6. Which of the following induction agents is known for its hemodynamic stability, making it a preferred choice in potentially hypotensive patients?

Propofol
Midazolam
Thiopental
Ketamine (Correct answer)

Correct answer: Ketamine

Ketamine is often the preferred induction agent in hemodynamically unstable patients or those at risk for hypotension. It typically increases heart rate and blood pressure, which is beneficial in trauma settings. Etomidate is also known for its hemodynamic stability, but Ketamine is another primary choice, especially in the context of potential hypovolemia.

Question 56: What is the preferred route of administration for adenosine when treating a patient with supraventricular tachycardia (SVT)?

Intravenous push (IVP) (Correct answer)
Oral
Intramuscular
Subcutaneous

Correct answer: Intravenous push (IVP)

Adenosine has an extremely short half-life, typically only a few seconds, meaning it is rapidly metabolized in the body. To ensure it reaches the heart in a sufficiently concentrated bolus to effectively interrupt the re-entry pathway causing SVT, it must be administered as a rapid intravenous push, immediately followed by a saline flush.

Question 57: You are treating a patient with an acute inferior wall STEMI who develops severe hypotension (BP 70/40 mmHg) and bradycardia after receiving a sublingual nitroglycerin tablet. A right-sided ECG reveals ST elevation in V4R. Which of the following is the most appropriate immediate intervention?

Immediately perform transcutaneous pacing.
Administer a second dose of nitroglycerin.
Administer a 500 mL normal saline fluid bolus. (Correct answer)
Initiate a dopamine infusion to support blood pressure.

Correct answer: Administer a 500 mL normal saline fluid bolus.

The clinical presentation of hypotension and bradycardia following nitroglycerin administration in a patient with an inferior STEMI, confirmed by ST elevation in V4R, is highly suggestive of a right ventricular myocardial infarction (RVMI). These patients are highly dependent on preload to maintain cardiac output. Nitrates and other preload-reducing agents are contraindicated. The first-line treatment is fluid resuscitation with an isotonic crystalloid, such as normal saline, to increase RV preload and improve cardiac output. Inotropes like dopamine may be needed if fluid therapy is insufficient, but volume expansion is the initial priority. Pacing would be indicated for symptomatic bradycardia unresponsive to other measures, but addressing the preload deficit is the primary concern.

Question 58: Patient-ventilator dyssynchrony during transport is BEST identified by:

Consistently low SpO2 despite high FiO2
Observation of patient effort against the ventilator and irregular waveforms (Correct answer)
High end-tidal CO2 readings
Decreasing mean arterial pressure

Correct answer: Observation of patient effort against the ventilator and irregular waveforms

Dyssynchrony is identified by observing the patient fighting the ventilator, accessory muscle use, and irregular flow/pressure waveforms on the ventilator.

Question 59: What is the recommended lung-protective tidal volume for a mechanically ventilated adult patient during critical care transport?

10-12 mL/kg actual body weight
6-8 mL/kg ideal body weight (Correct answer)
4-5 mL/kg ideal body weight
8-10 mL/kg actual body weight

Correct answer: 6-8 mL/kg ideal body weight

Lung-protective ventilation targets 6-8 mL/kg of ideal body weight to minimize ventilator-induced lung injury.

Question 60: A patient in septic shock remains hypotensive after norepinephrine uptitration. Which second-line vasopressor is recommended to spare catecholamine dosing?

Epinephrine 0.01-0.1 mcg/kg/min
Angiotensin II
Vasopressin 0.03-0.04 units/min (Correct answer)
Phenylephrine 100-180 mcg/min

Correct answer: Vasopressin 0.03-0.04 units/min

Vasopressin at 0.03-0.04 units/min is the standard add-on vasopressor for refractory septic shock, acting via V1 receptors independently of adrenergic pathways.

Question 61: A patient presents with confusion, headache, and vomiting after being found in a running car in a closed garage. What is the most likely diagnosis?

Heatstroke
Drug overdose
Carbon monoxide poisoning (Correct answer)
Hypoglycemia

Correct answer: Carbon monoxide poisoning

The scenario of a running car in a closed garage strongly indicates exposure to carbon monoxide (CO). CO is an odorless, colorless gas produced by incomplete combustion, and its poisoning causes symptoms like confusion, headache, and vomiting by binding to hemoglobin and preventing oxygen transport to tissues.

Question 62: When treating refractory septic shock with vasopressors, which agent is the FIRST-LINE choice per Surviving Sepsis guidelines?

Dopamine
Epinephrine
Vasopressin
Norepinephrine (Correct answer)

Correct answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock, providing potent alpha-mediated vasoconstriction with moderate beta-1 effects to raise MAP.

Question 63: During the secondary survey of a patient, what is the main focus?

Administering pain relief medications
Conducting a thorough head-to-toe examination (Correct answer)
Initiating intravenous fluids
Stabilizing life-threatening injuries

Correct answer: Conducting a thorough head-to-toe examination

After the primary survey has identified and managed immediate life-threatening conditions, the secondary survey focuses on a thorough, systematic head-to-toe examination. Its purpose is to identify all injuries, both obvious and subtle, that may not be immediately life-threatening but require attention and management.

Question 64: During a winter flight in a rotor-wing aircraft, the flight crew notes that the pressure gauge on their main oxygen cylinder reads lower than it did during their pre-flight check in the heated hangar. This phenomenon is best explained by:

Dalton's Law
Charles's Law
Gay-Lussac's Law (Correct answer)
Boyle's Law

Correct answer: Gay-Lussac's Law

Gay-Lussac's Law states that for a fixed volume of gas, the pressure is directly proportional to its absolute temperature. As the helicopter flies in the cold air, the temperature of the oxygen cylinder and the gas inside it decreases. This drop in temperature causes a corresponding decrease in the pressure of the gas within the cylinder.

Question 65: A flight crew is managing a patient with a difficult airway. After two failed intubation attempts, they are unable to ventilate the patient effectively with a bag-valve-mask. According to difficult airway algorithms, what is the immediate priority?

Proceeding to a rescue airway device or surgical airway (Correct answer)
Placing the patient in a sniffing position and re-attempting BVM
Attempting intubation with a different blade
Administering another dose of paralytic

Correct answer: Proceeding to a rescue airway device or surgical airway

In a 'cannot intubate, cannot ventilate' (CICV) situation, the primary goal shifts from intubation to oxygenation. Difficult airway algorithms stress moving systematically to the next step when a technique fails. After failed intubation and failed BVM ventilation, the immediate priority is to establish an airway via other means, such as a supraglottic airway or, if that fails or is not possible, a surgical cricothyrotomy.

Question 66: You are transporting a hiker found unconscious after being lost in the mountains during winter. His core temperature is 27°C (80.6°F) and the cardiac monitor shows ventricular fibrillation. According to advanced life support guidelines for severe hypothermia, what is the most appropriate action?

Immediately administer standard ACLS medications, such as epinephrine and amiodarone, at the usual intervals.
Attempt a single defibrillation, then focus on high-quality CPR and active rewarming, withholding further shocks and drugs until the core temperature is >30°C. (Correct answer)
Withhold all resuscitation efforts as the patient has been in arrest for a prolonged period and is considered clinically dead.
Provide aggressive chest compressions and defibrillate every two minutes until the core temperature rises.

Correct answer: Attempt a single defibrillation, then focus on high-quality CPR and active rewarming, withholding further shocks and drugs until the core temperature is >30°C.

In severe hypothermic cardiac arrest (core temperature <30°C or 86°F), the myocardium is extremely cold and irritable, making it refractory to both medications and repeated electrical shocks. [2] Current guidelines recommend attempting a single defibrillation for a shockable rhythm. If unsuccessful, the focus should shift to continuous high-quality CPR and rapid, active core rewarming. Further defibrillation attempts and the administration of IV drugs are typically withheld until the core temperature has been raised to at least 30°C (86°F), as drug metabolism is slowed and repeated shocks are unlikely to be effective. [2, 31]

Question 67: An anaphylactic patient remains hypotensive after 2 doses of IM epinephrine and 2L IV fluid. What is the next pharmacological intervention?

Glucagon 1 mg IV if on beta-blockers
Diphenhydramine 50 mg IV
Methylprednisolone 125 mg IV
Epinephrine IV infusion at 0.1-0.5 mcg/kg/min (Correct answer)

Correct answer: Epinephrine IV infusion at 0.1-0.5 mcg/kg/min

Refractory anaphylactic shock unresponsive to IM epinephrine requires IV epinephrine infusion for continuous vasopressor and bronchodilatory support.

Question 68: In the case of suspected opioid overdose with respiratory depression, what is the most appropriate initial action?

Administer naloxone (Correct answer)
Provide oxygen via nasal cannula
Place the patient in a recovery position
Start CPR immediately

Correct answer: Administer naloxone

In cases of suspected opioid overdose with respiratory depression, administering naloxone is the most appropriate initial action. Naloxone is an opioid antagonist that rapidly reverses the life-threatening respiratory depression caused by opioids, restoring spontaneous breathing and preventing further hypoxia and brain injury.

Question 69: What is the primary mechanism by which tranexamic acid (TXA) improves outcomes in hemorrhagic shock?

Replaces consumed coagulation factors
Stimulates clotting factor synthesis
Inhibits fibrinolysis by blocking plasminogen activation (Correct answer)
Causes direct vasoconstriction

Correct answer: Inhibits fibrinolysis by blocking plasminogen activation

Tranexamic acid competitively inhibits plasminogen activation, preventing clot breakdown (fibrinolysis) and preserving existing thrombus in hemorrhagic wounds.

Question 70: A neonate delivered at 28 weeks requires intubation. What is the correct ET tube size?

3.5 mm cuffed
2.5 mm uncuffed (Correct answer)
2.0 mm uncuffed
3.0 mm uncuffed

Correct answer: 2.5 mm uncuffed

A 2.5 mm uncuffed ET tube is appropriate for preterm neonates less than 1,000 g or less than 28 weeks gestation per NRP guidelines.

Question 71: A high-pressure alarm is triggered on the transport ventilator. Which of the following is the LEAST likely cause?

ETT cuff deflation (Correct answer)
Endotracheal tube kinking
Patient biting the tube
Right mainstem intubation

Correct answer: ETT cuff deflation

ETT cuff deflation would cause a leak and low-pressure/low-volume alarm, not a high-pressure alarm.

Question 72: A post-partum patient develops heavy vaginal bleeding unresponsive to fundal massage. What is the most common cause of postpartum hemorrhage?

Uterine atony (Correct answer)
Retained placenta
Cervical laceration
Coagulopathy

Correct answer: Uterine atony

Uterine atony accounts for approximately 80% of postpartum hemorrhage cases and is the most common cause.

Question 73: A patient presents with Beck's triad (hypotension, muffled heart sounds, jugular venous distension). Which type of shock does this suggest?

Hypovolemic shock
Cardiogenic shock from MI
Obstructive shock from cardiac tamponade (Correct answer)
Distributive shock from sepsis

Correct answer: Obstructive shock from cardiac tamponade

Beck's triad is pathognomonic for cardiac tamponade, which causes obstructive shock by preventing adequate ventricular filling.

Question 74: When administering magnesium sulfate, which antidote must be immediately available?

Naloxone 0.4 mg IV
Calcium gluconate 1 g IV (Correct answer)
Flumazenil 0.2 mg IV
Sodium bicarbonate 1 mEq/kg IV

Correct answer: Calcium gluconate 1 g IV

Calcium gluconate 1 g IV is the antidote for magnesium toxicity and should always be available at the bedside during magnesium infusion.

Question 75: In the context of trauma care, what does the acronym "MARCH" stand for?

Manage, Assess, Reassess, Care, Help
Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury (Correct answer)
Monitor, Airway, Resuscitate, Control, Hemorrhage
Maintain, Assess, Rest, Cool, Handle

Correct answer: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head injury

The MARCH algorithm is a tactical trauma assessment and treatment sequence, prioritizing interventions to maximize survival in situations with limited resources or prolonged care. It stands for Massive hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head injury, emphasizing control of major bleeding as the immediate priority.

Question 76: You are treating a 15 kg pediatric patient in hypovolemic shock secondary to gastroenteritis. According to Pediatric Advanced Life Support (PALS) guidelines, what is the appropriate initial isotonic crystalloid fluid bolus?

300 mL (20 mL/kg) (Correct answer)
500 mL (a standard bolus for all ages)
150 mL (10 mL/kg)
600 mL (40 mL/kg)

Correct answer: 300 mL (20 mL/kg)

PALS guidelines recommend an initial fluid bolus of 20 mL/kg of an isotonic crystalloid (such as Normal Saline or Lactated Ringer's) for pediatric patients in hypovolemic or septic shock, administered over 5-20 minutes. For a 15 kg child, this calculates to 300 mL (15 kg x 20 mL/kg).

Question 77: During a flight transport, a laboring patient delivers the head but the shoulders become impacted. What is the FIRST maneuver to attempt?

Woods screw maneuver
McRoberts maneuver with suprapubic pressure (Correct answer)
Zavanelli maneuver
Posterior arm delivery

Correct answer: McRoberts maneuver with suprapubic pressure

McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line intervention for shoulder dystocia.

Question 78: In the immediate aftermath of an aircraft accident, once personal safety is assured and the risk of fire is mitigated, what is the crew's highest priority according to survival training?

Building a shelter.
Performing a detailed inventory of all medical supplies.
Securing a water source.
Activating the Emergency Locator Transmitter (ELT). (Correct answer)

Correct answer: Activating the Emergency Locator Transmitter (ELT).

The primary goal after an aircraft crash, once immediate life threats like fire are addressed, is to ensure rescue. Activating the ELT or other signaling devices is the most critical step to alert search and rescue teams to the location. While shelter, water, and inventory are all important survival tasks, they are secondary to initiating the rescue process.

Question 79: In which situation is the administration of naloxone indicated?

Hypoglycemia with altered mental status
Anaphylaxis with airway compromise
Seizures due to benzodiazepine overdose
Opioid overdose with respiratory depression (Correct answer)

Correct answer: Opioid overdose with respiratory depression

Naloxone is a pure opioid antagonist that rapidly reverses the effects of opioid medications by binding to opioid receptors and blocking their activation. Its administration is specifically indicated for opioid overdose, particularly when respiratory depression, a life-threatening complication, is present.

Question 80: At altitude (e.g., 8,000 ft cabin altitude), which change in a ventilated patient's gas volumes should the flight paramedic anticipate?

PEEP levels automatically increase to compensate
Delivered tidal volumes will decrease due to increased atmospheric pressure
Gas volumes will expand due to decreased atmospheric pressure (Boyle's Law) (Correct answer)
Oxygen partial pressure increases, improving oxygenation

Correct answer: Gas volumes will expand due to decreased atmospheric pressure (Boyle's Law)

Per Boyle's Law, as altitude increases and atmospheric pressure decreases, gas volumes expand, which can affect tidal volume accuracy on some ventilators.

Question 81: A flight crew is transporting a 45-year-old male who was involved in a high-speed motor vehicle collision. The patient presents with a GCS of 6, an ipsilateral dilated and non-reactive pupil, and contralateral hemiparesis. These findings are most indicative of which neurological emergency?

Autonomic dysreflexia
Subdural hematoma
Uncal herniation (Correct answer)
Central cord syndrome

Correct answer: Uncal herniation

The classic triad of an ipsilateral dilated pupil (due to compression of the oculomotor nerve), contralateral hemiparesis (due to compression of the cerebral peduncle), and a decreased level of consciousness is the hallmark of uncal herniation. [1, 5] This is a life-threatening condition where the uncus of the temporal lobe is displaced inferiorly through the tentorial notch.

Question 82: Which of the following is a recognized criterion for initiating non-invasive positive pressure ventilation (NIPPV) during transport?

Bilateral flail chest with tension pneumothorax
Hemoptysis with SpO2 less than 80%
Acute hypercapnic respiratory failure with intact airway reflexes (Correct answer)
GCS of 8 or less with inability to protect airway

Correct answer: Acute hypercapnic respiratory failure with intact airway reflexes

NIPPV (CPAP/BiPAP) is appropriate for cooperative patients with acute hypercapnic respiratory failure who can protect their airway.

Question 83: Which sign differentiates placental abruption from placenta previa on physical assessment?

Soft non-tender uterus
Painless bright-red bleeding
Presentation abnormality on palpation
Painful uterine rigidity (Correct answer)

Correct answer: Painful uterine rigidity

Placental abruption typically presents with painful, rigid ('board-like') uterus, contrasting with the painless bleeding of placenta previa.

Question 84: You are transporting a patient with a left ventricular assist device (LVAD) who is now complaining of a severe headache and appears confused. The LVAD controller is alarming for high power consumption. What is the most likely cause of this presentation?

Controller malfunction
Gastrointestinal bleeding
Pump thrombosis (Correct answer)
Driveline infection

Correct answer: Pump thrombosis

Pump thrombosis can obstruct blood flow through the LVAD, causing the motor to work harder and leading to high power consumption alarms. The obstruction can lead to reduced systemic perfusion and an increased risk of thromboembolic events, such as a stroke, which would present with headache and confusion. While GI bleeding is a common complication in LVAD patients, it typically presents with signs of blood loss, not high power alarms. Driveline infections are also common but would present with localized or systemic signs of infection. A controller malfunction is possible, but the combination of neurological symptoms and a specific high-power alarm strongly points to a physiological problem like a thrombus.

Question 85: Which of the following is the most appropriate initial intervention for a patient in hemorrhagic shock?

Applying pressure to the bleeding site and initiating fluid resuscitation (Correct answer)
Elevating the legs and applying cold packs
Transporting the patient without any intervention
Administering high-flow oxygen and giving pain relief

Correct answer: Applying pressure to the bleeding site and initiating fluid resuscitation

Hemorrhagic shock results from severe blood loss, leading to inadequate tissue perfusion. The most appropriate initial interventions are to directly address the cause by stopping the bleeding through direct pressure and to restore circulating volume by initiating fluid resuscitation. This dual approach aims to stabilize the patient and prevent further deterioration.

Question 86: Which of the following is the primary advantage of pressure-control ventilation over volume-control ventilation?

Limits peak airway pressure and reduces barotrauma risk (Correct answer)
Guaranteed tidal volume delivery
Eliminates the need for sedation
Guaranteed minute ventilation

Correct answer: Limits peak airway pressure and reduces barotrauma risk

Pressure-control ventilation delivers breaths to a set pressure limit, which protects against high peak airway pressures and barotrauma.

Question 87: Which of the following laboratory and clinical findings is most characteristic of Diabetic Ketoacidosis (DKA) as opposed to Hyperosmolar Hyperglycemic State (HHS)?

Significant metabolic acidosis with an elevated anion gap. (Correct answer)
Profound dehydration with serum glucose > 800 mg/dL.
Normal or only slightly elevated serum osmolality.
The presence of some endogenous insulin, which prevents ketosis.

Correct answer: Significant metabolic acidosis with an elevated anion gap.

The defining feature that distinguishes DKA from HHS is the presence of significant ketosis and a subsequent anion gap metabolic acidosis. [4, 23] In DKA, an absolute insulin deficiency leads to lipolysis and the production of acidic ketone bodies. HHS is characterized by a relative insulin deficiency, which is enough to prevent significant ketosis but not enough to prevent extreme hyperglycemia, leading to more profound dehydration and hyperosmolality. [10, 16, 27]

Question 88: A patient at 34 weeks presents with generalized tonic-clonic seizures. After confirming she is pregnant, which immediate assessment finding helps differentiate eclampsia from other seizure causes?

Focal neurological deficit
BP greater than 160/110 mmHg with proteinuria (Correct answer)
History of prior seizure disorder
Temperature above 38.5°C

Correct answer: BP greater than 160/110 mmHg with proteinuria

Eclampsia is characterized by new-onset seizures in the context of severe hypertension (≥160/110) and proteinuria in the third trimester.

Question 89: A 45-year-old diabetic patient is found unconscious with a blood glucose level of 30 mg/dL. What is the most appropriate initial treatment?

Administer 50% dextrose intravenously (Correct answer)
Administer 1 mg of glucagon intramuscularly
Provide oral glucose if the patient regains consciousness
Administer insulin subcutaneously

Correct answer: Administer 50% dextrose intravenously

For an unconscious diabetic patient with severe hypoglycemia (blood glucose 30 mg/dL), intravenous 50% dextrose provides an immediate and concentrated source of glucose directly to the bloodstream. This rapidly raises blood sugar levels, reversing the neurological effects of hypoglycemia and restoring brain function.

Question 90: A diver who ascended too rapidly is being transported for suspected decompression sickness. The formation of nitrogen bubbles in the blood and tissues is primarily explained by which gas law?

Gay-Lussac's Law
Henry's Law (Correct answer)
Boyle's Law
Dalton's Law

Correct answer: Henry's Law

Henry's Law states that the amount of gas dissolved in a liquid is directly proportional to the partial pressure of that gas above the liquid. During a dive, increased ambient pressure causes more nitrogen to dissolve in the diver's blood and tissues. If the diver ascends too quickly, the ambient pressure drops rapidly, and the dissolved nitrogen comes out of solution to form bubbles, leading to decompression sickness.

Question 91: During the management of a patient with a suspected aneurysmal subarachnoid hemorrhage (SAH), which of the following is a primary goal to prevent re-bleeding?

Administering hypotonic fluids to hydrate brain tissue
Strict blood pressure control, typically targeting a systolic BP < 160 mmHg (Correct answer)
Placing the patient in the Trendelenburg position to increase venous return
Maintaining a systolic blood pressure > 180 mmHg to ensure cerebral perfusion

Correct answer: Strict blood pressure control, typically targeting a systolic BP < 160 mmHg

In a patient with a suspected or confirmed aneurysmal subarachnoid hemorrhage, strict blood pressure control is crucial to prevent re-bleeding, which is a major cause of mortality. [18, 35] Guidelines recommend maintaining a systolic blood pressure below 160 mmHg until the aneurysm is secured. [18, 30] Hypotension must also be avoided to maintain adequate cerebral perfusion pressure.

Question 92: A patient intubated for respiratory failure has an ETCO2 waveform that shows a rising baseline (capnographic 'shark fin' pattern with elevation). This most likely indicates:

Hyperventilation with low CO2
Pulmonary edema causing washout effect
Esophageal intubation
Air trapping and incomplete exhalation (obstructive pattern) (Correct answer)

Correct answer: Air trapping and incomplete exhalation (obstructive pattern)

A rising ETCO2 baseline ('shark fin' waveform) indicates incomplete exhalation and CO2 accumulation between breaths, consistent with obstructive physiology.

Question 93: In hemorrhagic shock, what is the maximum crystalloid volume recommended before transitioning to blood products per damage control resuscitation principles?

2 L
1-1.5 L (Correct answer)
500 mL
3 L

Correct answer: 1-1.5 L

Damage control resuscitation limits crystalloid to 1-1.5 L before transitioning to blood products to avoid dilutional coagulopathy and excessive interstitial edema.

Question 94: Which medication is most appropriate for the management of bradycardia in a pre-hospital setting?

Atropine (Correct answer)
Adenosine
Amiodarone
Dopamine

Correct answer: Atropine

Atropine is an anticholinergic medication that blocks the effects of acetylcholine on the vagus nerve, which normally slows the heart rate. By blocking vagal stimulation, atropine increases the heart rate and improves atrioventricular conduction, making it the primary drug for symptomatic bradycardia in the pre-hospital setting.

Question 95: A 24-year-old female presents with unilateral lower abdominal pain, vaginal spotting, and a positive pregnancy test. Her BP is 80/50 and HR 130. What is the priority intervention?

Obtain ultrasound before treatment
Pelvic exam to confirm diagnosis
Administer methotrexate
Large-bore IV access, fluid resuscitation, and emergent transport (Correct answer)

Correct answer: Large-bore IV access, fluid resuscitation, and emergent transport

Ruptured ectopic pregnancy causes life-threatening hemorrhage; immediate IV access, volume resuscitation, and rapid transport to surgical care are the priority.

Question 96: A 22-year-old male with a history of sickle cell disease is being transported with acute-onset chest pain, fever, and a new infiltrate on his chest x-ray. He is hypoxic with an SpO2 of 88% on a non-rebreather mask. This clinical picture is most consistent with which life-threatening complication?

Vaso-occlusive pain crisis
Splenic sequestration
Acute Chest Syndrome (ACS) (Correct answer)
Aplastic crisis

Correct answer: Acute Chest Syndrome (ACS)

Acute Chest Syndrome (ACS) is a form of acute lung injury and a leading cause of death in patients with sickle cell disease. [35] It is clinically defined by the presence of a new pulmonary infiltrate on chest x-ray combined with fever and/or respiratory symptoms such as chest pain, cough, or hypoxia. [11, 30, 34] While a vaso-occlusive crisis causes severe pain, the combination of respiratory symptoms and a new infiltrate specifically points to ACS.

Question 97: When transporting a ventilated patient with suspected ARDS, which ventilator strategy is supported by evidence to reduce mortality?

Pressure support ventilation without PEEP
Inverse I:E ratio ventilation with no PEEP
High tidal volumes (10-12 mL/kg IBW) with low PEEP
Low tidal volumes (6 mL/kg IBW) with adequate PEEP (Correct answer)

Correct answer: Low tidal volumes (6 mL/kg IBW) with adequate PEEP

The ARDSNet protocol supports low tidal volume (6 mL/kg IBW) with PEEP titration to reduce mortality in ARDS patients.

Question 98: You are transporting a patient who was stabbed in the right side of his neck. He is experiencing ipsilateral (right-sided) loss of motor function, proprioception, and vibration sense, with contralateral (left-sided) loss of pain and temperature sensation below the level of the injury. This specific pattern of neurological deficit is known as:

Anterior Cord Syndrome
Brown-Séquard Syndrome (Correct answer)
Central Cord Syndrome
Posterior Cord Syndrome

Correct answer: Brown-Séquard Syndrome

Brown-Séquard syndrome results from hemisection of the spinal cord. It is characterized by the ipsilateral loss of motor function (corticospinal tract) and proprioception/vibration sense (dorsal columns), and contralateral loss of pain and temperature sensation (spinothalamic tract), which crosses over at the level of the spinal cord. [7, 13]

Question 99: During the transport of a mechanically ventilated patient, you notice the capnography waveform does not return to the baseline of zero at the end of exhalation. This finding is most consistent with:

Hyperventilation
Inadequate paralytic agent
Pulmonary embolism
Rebreathing of carbon dioxide (Correct answer)

Correct answer: Rebreathing of carbon dioxide

When the capnography waveform does not return to zero, it indicates that the patient is inhaling air that still contains carbon dioxide. This is known as rebreathing and can be caused by a faulty expiratory valve in the ventilator circuit, inadequate fresh gas flow, or an exhausted CO2 absorber in a rebreathing system.

Question 100: A flight paramedic is managing a patient with circumferential full-thickness burns to the left leg. Which assessment finding is the EARLIEST and most reliable indicator of developing compartment syndrome requiring a potential escharotomy?

Loss of palpable dorsalis pedis pulse.
Pain disproportionate to the injury, described as deep and throbbing. (Correct answer)
Slow capillary refill (>3 seconds) in the toes.
Cool, pale skin on the distal extremity.

Correct answer: Pain disproportionate to the injury, described as deep and throbbing.

Severe, deep, and throbbing pain that is out of proportion to the visible injury is the earliest and most sensitive sign of compartment syndrome. The other signs, such as pulselessness, pallor, and delayed capillary refill, are later and more ominous findings that indicate significant vascular compromise has already occurred. Intervention should be considered before the loss of pulses, as irreversible ischemic injury may have already started by that point.

Question 101: You are transporting a 70 kg patient with 40% TBSA deep partial-thickness burns sustained 2 hours ago. The patient also has a closed femur fracture and is hypotensive. According to standard burn resuscitation principles, which fluid management strategy is most appropriate?

Administer crystalloids based on the Parkland formula but anticipate higher fluid requirements due to the concurrent trauma. (Correct answer)
Start fluid resuscitation using the Parkland formula (4 mL/kg/%TBSA) and titrate to a urine output of 30-50 mL/hr.
Use the Modified Brooke formula (2 mL/kg/%TBSA) to avoid fluid overload in a trauma patient.
Initiate a rapid 2L bolus of normal saline to treat traumatic hypotension first.

Correct answer: Administer crystalloids based on the Parkland formula but anticipate higher fluid requirements due to the concurrent trauma.

Patients with combined burn and trauma injuries often require more fluid than predicted by standard burn formulas alone. The initial approach should be guided by the Parkland formula, but the flight paramedic must anticipate the need for additional volume due to the femur fracture and associated blood loss. While boluses may be needed for profound hypotension from trauma, the primary burn resuscitation should be a steady, titrated infusion. Simply using a standard formula without considering the traumatic injury may lead to under-resuscitation. The Modified Brooke formula might be insufficient in this complex trauma scenario.

Question 102: A farm worker presents with diaphoresis, lacrimation, urination, defecation, and pinpoint pupils. He has copious bronchial secretions and is bradycardic. This presentation is classic for exposure to which class of toxin?

Sympathomimetics
Carbon monoxide
Organophosphates (Correct answer)
Tricyclic antidepressants

Correct answer: Organophosphates

This patient is exhibiting signs of a cholinergic crisis, caused by excessive acetylcholine stimulation. Organophosphates, commonly found in insecticides, are acetylcholinesterase inhibitors. They prevent the breakdown of acetylcholine, leading to its accumulation and the overstimulation of muscarinic and nicotinic receptors. [6, 24] The symptoms can be recalled using mnemonics like DUMBELS (Diaphoresis/Diarrhea, Urination, Miosis, Bradycardia/Bronchorrhea, Emesis, Lacrimation, Salivation) or SLUDGEM. [13, 26, 29]

Question 103: Which ventilator parameter most directly reflects alveolar plateau pressure and risk of barotrauma?

Mean airway pressure
PEEP
Plateau pressure (Correct answer)
Peak inspiratory pressure

Correct answer: Plateau pressure

Plateau pressure reflects static alveolar distending pressure and should be kept below 30 cmH2O to reduce barotrauma risk.

Question 104: A transport ventilator's low-minute-volume alarm activates. Which assessment finding is MOST consistent with this alarm?

High peak inspiratory pressures with full tidal volumes
Decreased end-tidal CO2 and increased respiratory rate
Improved SpO2 and reduced work of breathing
Increased end-tidal CO2 and decreased tidal volume delivery (Correct answer)

Correct answer: Increased end-tidal CO2 and decreased tidal volume delivery

Low minute volume (reduced tidal volume or rate) means less CO2 elimination, causing ETCO2 to rise, consistent with hypoventilation.

Question 105: A 45-year-old male involved in a house fire has full-thickness circumferential burns to his entire right arm and anterior chest. He is intubated for suspected inhalation injury. During transport, you note increasing ventilator peak pressures, decreasing SpO2, and absent radial pulse on the right side with a weak carotid pulse. What is the most critical intervention?

Perform a needle decompression of the chest.
Increase the IV fluid resuscitation rate.
Administer a fluid bolus and vasopressors.
Immediately perform a chest and arm escharotomy. (Correct answer)

Correct answer: Immediately perform a chest and arm escharotomy.

The patient's signs and symptoms—rising peak airway pressures, hypoxia, and loss of distal pulse in the circumferentially burned arm—are classic indicators of compartment syndrome secondary to a constricting eschar. An escharotomy of the chest is urgently needed to allow for adequate ventilation, and an escharotomy of the arm is required to restore circulation. While fluid resuscitation is crucial, it will not resolve the mechanical constriction. There are no signs of a tension pneumothorax, making needle decompression inappropriate. Vasopressors and fluid boluses will not restore perfusion if the underlying problem is a physical constriction.

Question 106: A flight crew is transporting a 34-week pregnant female with severe preeclampsia who begins to have a tonic-clonic seizure. Which of the following is the first-line medication for seizure control in this eclamptic patient?

Magnesium Sulfate (Correct answer)
Lorazepam
Phenytoin
Levetiracetam

Correct answer: Magnesium Sulfate

Magnesium sulfate is the drug of choice for both the prevention and treatment of eclamptic seizures. [1, 14, 19] It acts as a central nervous system depressant and membrane stabilizer to control and prevent further seizure activity. While benzodiazepines like lorazepam may be used for refractory seizures, magnesium sulfate is the initial and primary intervention recommended by major clinical guidelines. [12, 32]

Question 107: You are transporting a patient with COPD from a rural facility at sea level to a tertiary care center located at a higher elevation. According to Dalton's Law, what physiological challenge should you anticipate?

Decreased oxygen cylinder duration due to temperature changes.
Expansion of gases in the bullae, causing a pneumothorax.
Increased FiO2 requirement due to lower partial pressure of oxygen. (Correct answer)
Increased risk of decompression sickness.

Correct answer: Increased FiO2 requirement due to lower partial pressure of oxygen.

Dalton's Law states that the total pressure of a gas mixture is the sum of the partial pressures of each gas. While the percentage of oxygen in the atmosphere remains 21% at altitude, the total atmospheric pressure is lower. This results in a decreased partial pressure of inspired oxygen (PiO2), leading to hypoxic hypoxia. Patients with pre-existing respiratory conditions like COPD will likely require an increased FiO2 to maintain adequate oxygen saturation.

Question 108: During neonatal resuscitation, what is the target peripheral oxygen saturation 5 minutes after birth in a term infant?

70-75%
96-100%
90-95%
80-85% (Correct answer)

Correct answer: 80-85%

NRP guidelines specify a target SpO2 of 80-85% at 5 minutes after birth for term neonates, reflecting normal transitional physiology.

Question 109: A 28-year-old female is found unconscious after a suspected intentional overdose. Her ECG shows a heart rate of 120, a QRS complex of 140 ms, and a prominent terminal R wave in lead aVR. Which medication overdose is most likely responsible for these findings, and what is the primary treatment?

Digoxin toxicity; Digoxin immune Fab
Calcium channel blocker toxicity; Calcium Chloride
Beta-blocker toxicity; Glucagon
Tricyclic antidepressant (TCA) toxicity; Sodium Bicarbonate (Correct answer)

Correct answer: Tricyclic antidepressant (TCA) toxicity; Sodium Bicarbonate

The classic ECG findings of sinus tachycardia, a widened QRS complex (>100 ms), and a prominent terminal R wave in aVR are pathognomonic for significant cardiotoxicity from a tricyclic antidepressant overdose. [3, 9, 21] This toxicity is caused by the blockade of fast sodium channels in the myocardium. Sodium bicarbonate is the primary antidote; it increases the extracellular sodium concentration to overcome the channel blockade and increases serum pH, which reduces the affinity of the TCA for the sodium channels. [15, 18]

Question 110: Which finding on physical exam is MOST consistent with early (Class I) hemorrhagic shock?

Hypotension, tachycardia >120 bpm
Marked tachycardia, altered mental status
Undetectable BP and absent radial pulse
Anxiety, normal BP, pulse less than 100 bpm (Correct answer)

Correct answer: Anxiety, normal BP, pulse less than 100 bpm

Class I hemorrhagic shock (less than 15% blood loss) presents with minimal changes: slight anxiety, normal BP, and HR under 100 bpm.

Question 111: Permissive hypercapnia during mechanical ventilation is defined as intentionally allowing PaCO2 to rise above normal in order to:

Increase respiratory drive in spontaneously breathing patients
Minimize tidal volumes and ventilator-induced lung injury (Correct answer)
Reduce the need for sedation during transport
Improve oxygenation by shifting the oxyhemoglobin curve

Correct answer: Minimize tidal volumes and ventilator-induced lung injury

Permissive hypercapnia accepts elevated PaCO2 as a trade-off for using lower tidal volumes that reduce ventilator-induced lung injury.

Question 112: A pregnant patient at 20 weeks is found supine and unconscious. What positional intervention should be performed immediately?

Left lateral tilt or manual uterine displacement (Correct answer)
Semi-Fowler's position
Trendelenburg position
Right lateral tilt

Correct answer: Left lateral tilt or manual uterine displacement

Left lateral tilt or manual left uterine displacement relieves aortocaval compression by the gravid uterus, improving cardiac output.

Question 113: A patient at 36 weeks gestation presents with severe hypertension (180/110 mmHg), headache, and visual disturbances. Which medication is most appropriate for acute BP management in-flight?

Hydralazine or labetalol IV (Correct answer)
Nifedipine sublingual
Metoprolol PO
Sodium nitroprusside infusion

Correct answer: Hydralazine or labetalol IV

IV hydralazine or labetalol are first-line agents for acute severe hypertension in preeclampsia, as they are safe in pregnancy and allow titrated control.

Question 114: A patient with a traumatic brain injury begins to exhibit Cushing's triad. Which of the following sets of vital signs correctly represents this phenomenon?

Hypertension, tachycardia, and bradypnea
Hypotension, bradycardia, and tachypnea
Hypotension, tachycardia, and irregular respirations
Hypertension, bradycardia, and irregular respirations (Correct answer)

Correct answer: Hypertension, bradycardia, and irregular respirations

Cushing's triad is a physiological nervous system response to increased intracranial pressure (ICP). It consists of hypertension (often with a widening pulse pressure), bradycardia, and irregular respirations (such as Cheyne-Stokes or ataxic breathing). [4, 9, 11] It is a late and ominous sign of brainstem compression and impending herniation. [6]

Question 115: A post-cardiac arrest patient is being transported. Which target MAP should be maintained to optimize cerebral perfusion per post-ROSC care guidelines?

≥55 mmHg
≥90 mmHg
≥65 mmHg (Correct answer)
≥80 mmHg

Correct answer: ≥65 mmHg

Post-ROSC guidelines recommend maintaining MAP ≥65 mmHg to optimize systemic and cerebral perfusion pressure during transport.

Question 116: Which hemodynamic profile is characteristic of distributive (septic) shock?

Low CO, high SVR, low MAP
High CO, high SVR, high MAP
Low CO, low SVR, low MAP
High CO, low SVR, low MAP (Correct answer)

Correct answer: High CO, low SVR, low MAP

Septic shock is characterized by high cardiac output from tachycardia, low systemic vascular resistance from vasodilation, and resultant low MAP.

Question 117: Which mnemonic is commonly used to gather a patient’s history during assessment

DCAP-BTLS
ABCDE
OPQRST
SAMPLE (Correct answer)

Correct answer: SAMPLE

The SAMPLE mnemonic is a crucial tool used by pre-hospital providers to efficiently gather a comprehensive patient history. It stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading to the injury/illness, providing vital information for diagnosis and treatment.

Question 118: CPAP differs from BiPAP primarily in that CPAP:

Provides higher pressure during inhalation than exhalation
Delivers a single continuous pressure throughout the respiratory cycle (Correct answer)
Is contraindicated in patients with hypoxemic respiratory failure
Can only be used with a face mask, not a nasal interface

Correct answer: Delivers a single continuous pressure throughout the respiratory cycle

CPAP provides a single constant pressure during both inhalation and exhalation, while BiPAP delivers higher inspiratory (IPAP) and lower expiratory (EPAP) pressures.

Question 119: During critical care transport, a ventilated patient develops sudden hypotension, rising peak airway pressures, and absent breath sounds on the left side. The PRIORITY intervention is:

Increase PEEP to 15 cmH2O to recruit the left lung
Needle thoracostomy on the left chest at the 2nd intercostal space, midclavicular line (Correct answer)
Administer 1 L IV crystalloid bolus immediately
Obtain 12-lead ECG to rule out MI

Correct answer: Needle thoracostomy on the left chest at the 2nd intercostal space, midclavicular line

Unilateral absent breath sounds with hypotension and rising airway pressures in a ventilated patient indicates tension pneumothorax requiring immediate needle decompression.

Question 120: What is the primary concern when managing a patient with a suspected spinal cord injury in a trauma situation?

Immobilizing the spine to prevent further injury (Correct answer)
Checking for a history of allergies
Ensuring the patient is comfortable
Administering pain medication immediately

Correct answer: Immobilizing the spine to prevent further injury

In a trauma situation with suspected spinal cord injury, the paramount concern is to prevent any further damage to the spinal cord. Immobilizing the spine minimizes movement, which can otherwise exacerbate an existing injury and lead to permanent neurological deficits or paralysis. All other options are secondary to this critical initial step.

Question 121: When ventilating a patient with chronic obstructive pulmonary disease (COPD) exacerbation, which ventilator adjustment is MOST important to prevent air trapping?

Increasing respiratory rate to 20-24 breaths/min
Increasing tidal volume to 10 mL/kg IBW
Using 100% FiO2 throughout transport
Prolonging expiratory time by using a lower I:E ratio (e.g., 1:3 to 1:4) (Correct answer)

Correct answer: Prolonging expiratory time by using a lower I:E ratio (e.g., 1:3 to 1:4)

COPD patients have obstructed airways requiring prolonged expiratory time; a lower I:E ratio (more expiratory time) reduces auto-PEEP and air trapping.

Question 122: A 68-year-old male is being transported by air after a complicated PCI for a large anterior STEMI. He is now in cardiogenic shock, supported by an intra-aortic balloon pump (IABP). You notice the diastolic augmentation on the IABP waveform is suddenly significantly reduced. Which of the following is the LEAST likely cause for this change?

The patient's cardiac output has significantly decreased.
The patient has developed severe aortic regurgitation. (Correct answer)
There is a helium leak in the IABP catheter or console.
The balloon has migrated distally and is now too low.

Correct answer: The patient has developed severe aortic regurgitation.

Severe aortic regurgitation is an absolute contraindication for IABP placement because diastolic augmentation would worsen the regurgitation, increasing LV preload and afterload. It is not a cause of poor diastolic augmentation but rather a condition that precludes its use. A distally migrated balloon, a helium leak (causing incomplete inflation), or a severe drop in the patient's native cardiac output are all potential causes of decreased diastolic augmentation.

Question 123: Which parameter is considered the most reliable indicator that a patient is ready for extubation during transport preparation?

Heart rate less than 100 beats per minute
Absence of secretions for more than 2 hours
SpO2 greater than 90% on FiO2 of 1.0
Negative inspiratory force (NIF) more negative than -20 cmH2O with GCS ≥ 10 (Correct answer)

Correct answer: Negative inspiratory force (NIF) more negative than -20 cmH2O with GCS ≥ 10

A NIF more negative than -20 cmH2O indicates adequate respiratory muscle strength, and a GCS ≥ 10 suggests the patient can protect the airway post-extubation.

Question 124: A 68-year-old female presents with acute onset of left-sided facial droop and right arm weakness that began exactly 2 hours ago. Her blood glucose is 110 mg/dL and a non-contrast CT scan shows no hemorrhage. Which of the following is an absolute contraindication for the administration of intravenous alteplase (tPA) in this patient?

The patient reports a major surgery 3 weeks ago
The patient's blood pressure is 190/115 mmHg (Correct answer)
The patient is 68 years old
The patient has a history of a previous stroke 4 years ago

Correct answer: The patient's blood pressure is 190/115 mmHg

According to the American Heart Association/American Stroke Association guidelines, a sustained blood pressure of systolic > 185 mmHg or diastolic > 110 mmHg is an absolute contraindication for IV alteplase. [23, 27] Blood pressure must be lowered and maintained below this threshold before tPA can be administered safely. The other options are not absolute contraindications in this specific scenario.

Question 125: Which of the following conditions is an absolute contraindication to the placement and use of an intra-aortic balloon pump (IABP)?

Severe aortic insufficiency (Correct answer)
Cardiogenic shock
Acute mitral regurgitation
Left main coronary artery stenosis

Correct answer: Severe aortic insufficiency

Severe aortic insufficiency (or regurgitation) is an absolute contraindication for IABP therapy. The IABP inflates during diastole to increase coronary perfusion pressure. In a patient with aortic insufficiency, this diastolic augmentation would force more blood back into the left ventricle, worsening the regurgitation, increasing left ventricular end-diastolic pressure (LVEDP), and exacerbating heart failure. Cardiogenic shock, acute mitral regurgitation, and critical coronary artery stenosis are all potential indications for IABP use.

Flight Paramedic Certification (FP-C)

The FP-C is a specialty board certification for experienced paramedics working in flight and critical care transport, testing advanced knowledge across airway management, cardiology, trauma, and transport medicine. It is administered by the International Board of Specialty Certifications (IBSC).

135

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150 min

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