Flight-Ground Transport, Nursing (CFRN/CTRN)
Flight-Ground Transport, Nursing CFRN/CTRN
A patient was orally intubated shortly prior to transport team arrival. There are no breath sounds on the left and the right chest is hyperinflated. What is the most appropriate initial intervention?
A. Withdraw the tube 2 cm and reassess lung sounds.
B. Remove the tube and immediately reintubate.
C. Examine the latest chest radiograph for tube location.
D. Decompress the chest at the right second intercostal space.
Answer: A. Withdraw the tube 2 cm and reassess lung sounds.
Unilateral breath sounds and chest hyperinflation in an intubated patient strongly suggest either mainstem intubation (almost always the right) or a significant pneumothorax. If available, a chest radiograph will reveal the location of the endotracheal tube (ETT) tip in relation to the carina, but tube location could easily have changed since the radiograph was obtained. First determine how deeply the ETT is inserted. As a rule of thumb, appropriate insertion depth is 3 times the tube diameter. For example, a size 8 tube is inserted to a depth of 24 cm (+/- 1 cm). If the tube is deeper, repositioning and breath sound reassessment are the most appropriate next steps. Tube removal is indicated if bilateral breath sounds are absent. Needle thoracostomy and chest tube placement are interventions for tension pneumothorax.
Prior to transport team arrival, first responders placed an air splint on a patient with a humeral deformity. Distal capillary refill time is 3 seconds and the skin is cool. What is the priority action?
A. Initiate rapid patient transport.
B. Deflate the splint and reassess.
C. Elevate the injured extremity.
D. Administer an IV crystalloid bolus.
Answer: B. Deflate the splint and reassess.
This patient is exhibiting evidence of circulatory compromise: delayed capillary refill and cool skin temperature. Because the pneumatic air splint was placed prior to transport team arrival, the etiology of the circulatory compromise is uncertain. These findings could be due to either the injury itself or to excessive splint inflation. Splint deflation will quickly reverse circulatory compromise and restore adequate perfusion if excessive air pressure was the cause. If there is no change in the neurovascular exam after deflation, re-splint the injury (with the air splint or another device). All of the other intervention options are appropriate once the threat to limb viability has been addressed. The importance of maintaining end organ perfusion by supporting the patient’s hemodynamic status must not be overlooked.
A medical crew is transporting a victim from the scene of an avalanche. Which of the following dermal findings would suggest the patient has third degree frostbite? The skin appears
A. blistered and red.
B. charred and black.
C. leathery and cyanotic.
D. waxy and white.
Answer: D. waxy and white.
Frostbite is part of a spectrum of cold related tissue injuries that range from superficial frostnip (first degree frostbite) to third and fourth degree injuries in which the muscles, tendons, blood vessels, and nerves all freeze. Prolonged exposure to severe cold freezes water in both the intracellular and extracellular spaces. This water expands, destroying cells, and unleashing a whole cascade of inflammatory mediators. Deeply frostbitten skin appears white, blotchy, or blue in color. The dermis looks and feels waxy and both sensation and function are lost. As the wound ages, deep frostbite evolves into areas of purplish, blood filled blisters that eventually turn black. A reddened skin appearance is associated with frostnip. Charred or leathery skin is found in conjunction with thermal burns rather than frostbite.
A transport team is caring for a patient in labor who is 29 weeks pregnant. Tocolytic agent options include
A. nifedipine, nicardipine, hydralazine.
B. nicardipine, magnesium sulfate, terbutaline.
C. hydralazine, nicardipine, magnesium sulfate.
D. magnesium sulfate, terbutaline, nifedipine.
Answer: D. magnesium sulfate, terbutaline, nifedipine.
Tocolytic agents (e.g., magnesium sulfate, terbutaline, and nifedipine) are administered to relax overactive uterine muscles and halt the ongoing cervical changes that lead to preterm delivery (<37 weeks). Magnesium decreases calcium influx into cells, limiting the ability of smooth muscles to contract. Terbutaline is a beta-mimetic that relaxes smooth muscles. Nifedipine is a calcium channel blocker that inhibits calcium influx into the cells, thwarting contraction. The goal of tocolytic therapy is to impede labor progression for at least 48 hours to allow time to transfer the mother to a high risk OB facility and to give the fetus an opportunity to respond to steroid therapy. Magnesium has long been used for preterm labor, but some studies suggest that oral nifedipine is just as effective and has fewer side effects.
A patient with a brainstem glioma exhibits diplopia, vomiting, and a rapidly decreasing level of consciousness. During transport, signs of deterioration include
A. bradycardia, Kussmaul respirations, & hypotension.
B. tachycardia, bradypnea, & narrowed pulse pressure.
C. tachycardia, Kussmaul respirations, & hypertension.
D. bradycardia, irregular respiration, a widened pulse pressure.
Answer: D. bradycardia, irregular respiration, & widened pulse pressure.
Cushing's triad is a set of clinical findings indicative of brainstem herniation. The triad consists of: 1) bradycardia, 2) an abnormal respiratory pattern, and 3) widened pulse pressure (or hypertension). Pulse pressure is the difference between the systolic and diastolic blood pressures. (PP = SBP-DBP). Pulse pressure widens when either systolic pressure rises or diastolic pressure drops. Other signs of increased ICP include mental status changes, papilledema, and vomiting. Intracranial hypertension is frequently the result of trauma (intracranial hemorrhage, edema, or contusion), but it can also be caused by many other acute and chronic conditions such as brain tumors, hydrocephalus, cerebral venous thrombosis, and certain medications and toxins.
Flight-Ground Transport, Nursing CFRN/CTRN
Flight-Ground Transport, Nursing CFRN/CTRN®
Pocket Study Guide Volume 1
Susan Thibeault MS RN CRNA CFRN CTRN
Laura M. Criddle PhD RN CEN CFRN CCRN FAEN