Flight-Ground Transport, Nursing (CFRN/CTRN)
Flight-Ground Transport, Paramedic FP-C/CCP-C
Heat loss in a blunt trauma patient in hemorrhagic shock is most effectively prevented during transport by
A. warmed blanket application.
B. heated IV fluid administration.
C. warmed crystalloid peritoneal lavage.
D. overhead heat lamp use.
Answer: B. Heated IV fluid administration
Warming infused fluids to approximately 39° C (102.2° F) minimizes heat loss associated with the administration of room temperature or refrigerated fluids. This is an important intervention in the patient receiving a large volume of crystalloids or blood products. However, heated fluid infusion is an inefficient way to rewarm a patient who is actually hypothermic. There are a number of inline fluid warming devices that heat both blood and crystalloids. These devices range from large rapid infusers to tiny portable devices. Standard cloth blankets stored in a blanket warmer lose their heat very quickly. Forced hot air blankets (e.g., the Bair Hugger) and heat lamps are much more effective. Peritoneal lavage is invasive and is reserved for patients with severe hypothermia; it is not used to PREVENT hypothermia.
The requirement to maintain a "sterile cockpit" can be waived
A. during takeoff if the weather is clear and visibility is good.
B. when landing at a major airport.
C. when flying through dense class B airspace.
D. during critical patient situations such as cardiac arrest.
Answer: D. during critical patient situations such as cardiac arrest.
Maintain sterile cockpit procedures (limit all pilot distractions) during takeoff and landing regardless of location or weather conditions. A sterile cockpit is also essential during any other critical flight phases. Traveling in dense class B airspace is considered a crucial phase of flight. However, in the event of a critical patient situation, sterile cockpit procedures may be waived in favor of urgent patient needs. If an emergent patient care situation occurs during a critical phase of flight, the pilot may choose to isolate crew transmissions to eliminate distractions in the cockpit.
A patient with recent ventricular assist device (VAD) insertion requires rotor wing transport at an altitude of 7,000 feet. The medical team can anticipate which transport-related complication?
A. Hypemic hypoxia
B. Decreased preload due to G forces
C. Hypoxic hypoxia
D. VAD malfunction due to vibration
Answer: C. Hypoxic hypoxia
Hypoxic hypoxia (altitude hypoxia) occurs when the amount of inspired oxygen (FiO2) is low. According to Dalton's law of partial pressure, the FiO2 doesn't change with altitude gains, but the total barometric pressure decreases, causing the partial pressure of oxygen to drop. Therefore, the alveolar partial pressure of oxygen (PAO2) dwindles as altitude climbs. The room air partial pressure of oxygen is 159 mm Hg at sea level. At an elevation of 7,000 feet it falls to only 118 mm Hg. In civilian transport aircraft, the effect of G forces is not a significant consideration. Hypemic hypoxia is the result of hemorrhagic hypovolemia or anemia. These conditions may be present in a patient, but are not caused by air transport. Transport vehicle vibration may interfere with monitoring equipment, but is not known to affect VAD function.
After administering succinylcholine, transport team members experience difficulty bag-mask ventilating a morbidly obese 54-year-old female. The patient's SpO2 is 84%. At this point, the priority intervention is to
A. use a two-handed jaw thrust and mask seal technique.
B. intubate the patient orally over a lighted stylet.
C. insert a laryngoscope and orally intubate the patient.
D. perform a surgical cricothyrotomy.
Answer: A. use a two-handed jaw thrust and mask seal technique.
If standard bag-mask techniques are ineffective and the patient is hypoxic, immediate improvement of oxygenation and ventilation is paramount. Bag-mask ventilation of the morbidly obese patient often requires a two-handed jaw thrust and mask seal maneuver--with both oral and nasal airways in place--because upper airway muscle relaxation causes the patient's pharyngeal tissues to collapse. This technique requires a second provider to deliver ventilations (4-hand ventilation). Cricothyrotomy can be extremely challenging in the morbidly obese patient; identification of anatomical landmarks is difficult. Oral intubation is unlikely to achieve oxygenation in a timely manner. A lighted stylet tip may not be visible through excessive neck soft tissue.
A 54-year old female was intubated for acute respiratory distress. There are copious, pink, frothy secretions in the endotracheal tube. Despite an FiO2 of 100%, the patient's SpO2 is 88%. The action most likely to improve oxygenation is to
A. administer intravenous furosemide.
B. add positive end expiratory pressure.
C. obtain an upright chest radiograph.
D. put the patient in semi-Fowler's position.
Answer: B. add positive end expiratory pressure.
If hypoxemia is not corrected by mechanical ventilation, further oxygenation improvements can be achieved by increasing end-expiratory lung volumes. This is accomplished with the addition of positive end-expiratory pressure (PEEP). PEEP recruits collapsed alveoli and maintains their inflation throughout the respiratory cycle. This mechanism is useful for patients with atelectasis, pneumonia, and ARDS. Additionally, PEEP is beneficial in the pulmonary edema patient because positive pressure within the alveoli counteracts fluid translocation from the capillaries and interstitium into the alveolar space. Furosemide is indicated for cardiogenic pulmonary edema, but it does not provide immediate hypoxic relief. Semi-Fowler's positioning reduces dyspnea and aerates the upper lobes, but it is not a definitive intervention.
Flight-Ground Transport, Paramedic FP-C/CCP-C
Flight-Ground Transport, Paramedic FP-C/CCP-C®
Pocket Study Guide Volume 1
Susan Thibeault MS RN CRNA EMT-P FP-C CCP-C
Laura M. Criddle PhD RN NREMT-P FP-C CCP-C