Mixed Deck — All FP-C Topics Flashcards

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?

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.

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:

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.

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?

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).

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?

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.

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?

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.

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:

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.

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?

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.

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

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.

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

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.

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?

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.

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?

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.

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

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.

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?

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.

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?

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.

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

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.

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

Answer: Inhibits fibrinolysis by blocking plasminogen activation

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

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?

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.

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

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.

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

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.

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

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.