C-NPT: Transport Considerations

 A patient has a diagnosis of a sequestered small bowel. When the aircraft ascends to a cruising altitude of 4,000 feet mean sea level (MSL), Boyle’s law could cause what?

A “sterile cockpit” refers to which phase of flight?

A 3-year-old, 20kg patient who had a recent traumatic injury secondary to an MVC, is suffering from aspiration pneumonia. They are unresponsive and intubated and have the following vitals: BP 78/40, HR 110, RR 20/assisted.  They are mechanically ventilated and have no spontaneous respirations.  Dopamine is infusing at 10 mcg/kg/min. Current ventilator settings are:  SIMV 20, PC 10, V_te 112, f 26, PEEP 5, and FiO₂ 0.6.  Current ABGs: pH 7.34, PaCO₂ 50 mmHg, HCO3^– 19, PaO₂ 50, and SpO₂ 90%.  What would the next treatment priority be?

A 5-year-old pediatric patient presents with a left lower leg fracture that has been splinted but not straightened. The child is now screaming with pain every time you try to do an assessment. What is your first action before transport?

A 6-month-old, 6kg patient recently underwent surgery and has the following ABG: pH 7.42, PaCO₂ 38, PaO₂ 52, HCO3^– 25.  Current ventilator settings: SIMV 28, V_te 34, f 32, PEEP 5, FiO₂ 0.6. What ventilator setting changes should be made?

A base receives a complaint that the pilot always chooses a landing zone (LZ) that is different from what the incident commander has assigned. How should this be handled?

A high-pressure alarm is alerting on the transport ventilator. Any of the following can lead to this EXCEPT?

A pediatric patient is diagnosed with acute cardiac collapse secondary to myocarditis. Upon assessment, the following are noted: BP 72/38, HR 128, RR 34, urine output of 30 mL over the past 3 hours, CVP 12 mmHg, PAP 32/26 mmHg, PCWP 23 mmHg, CI 1.7 L/min/m2.  When evaluating this patient’s glomerular filtration rate (GFR), what laboratory value would best be utilized?

A shift to the right on the oxyhemoglobin dissociation curve can be caused by which of the following?

A neonate has an order for continuous prostaglandin administration. What is the starting dose?

According to CAMTS standards, the flight team must depart within how many minutes from the initial time of the call?

According to Gay Lussac’s law, as the temperature of a gas increases, what else is expected?

An 8-year-old patient has suffered traumatic injuries secondary to abuse.  The patient has received three units of packed red blood cells (PRBCs).  The patient’s 2,3-DPG is anticipated to change and has what effect on the oxyhemoglobin dissociation curve?

An expanding endotracheal tube (ETT) in flight is an indication of which gas law?

Charles’s law is best defined as:

Charles’s law states that as you increase the temperature of a gas, you would expect:

Dalton’s law demonstrates that the concentration of oxygen at 43,000 feet mean sea level (MSL) will be?

Dalton’s law demonstrates that the concentration of O₂ at 18,000 feet mean sea level (MSL) is 21%.  If the barometric pressure at 18,000 feet MSL is 380 torr, what would the partial pressure of oxygen be at that altitude?

Dead space is calculated by using which formula?

During flight operations, at what altitude interval does the most significant change in atmospheric pressure occur?

During the morning briefing, the pilot states that current conditions are “1,000 and 3”. What would this mean to the flight crew?

During transport of a neonate, which of the following findings would indicate that the neonate is in stress?

During a 3-hour critical care transport in a rotor-wing aircraft, the flight crew notices that the patient’s blood sugar has decreased more than expected.  The tram suspects that this is likely due to which stressor of flight?

Federal aviation administration (FAA) guidelines state that an aeromedical program may only fly?

Flicker vertigo can cause seizures to occur at what hertz (Hz) range?

For every 10 mmHg change in PaCO₂, the pH will change by ____________ in the opposite direction?

Identify the following ABG: pH 7.28, PaCO2 20, HCO3- 17, PaO2 80, BE -8

Identify the following formula:

Identify the following pediatric patient’s ABG: pH 7.60, PaCO₂ 23, HCO3^– 35, PaO₂ 85.

Identify the medication with bronchodilating properties.

In 1985 Congress enacted COBRA; legislation requiring that the: 

In metabolic acidosis, what electrolyte becomes falsely elevated due to this acid-base disorder?

In volume control ventilation, it is most appropriate to monitor?

Intraosseous (IO) access is contraindicated with which of the following?

Labs show the patient’s current lactate level is 6.3 mmol/L.  What does this value suggest?

Noise from an aircraft can adversely affect a patient and crew during critical care transport. Which of the following is an example of this limitation?

Oxygen saturation (SpO₂) refers to the percentage of oxygen that is?

Pressure regulated volume control (PRVC) mode of ventilation uses a combination of volume and pressure.  How does this mode of ventilation accomplish this?

Synchronized intermittent mandatory ventilation (SIMV) is described as:

Temperature regulation in the neonate is limited by an immature hypothalamus and __________?

The dicrotic notch on the pulmonary artery waveform is reflective of what mechanical event in the heart?

The ELT is activated with an impact exceeding?

The equation for determining the endotracheal tube (ETT) size in a pediatric patient > 1-year-old is?

The flight crew has just experienced a crash landing of the aircraft, and the pilot has asked them to exit the aircraft. What should they take with them?

The flight crew is asked to respond to the scene of a pediatric trauma in an outlying area. The nearest available EMS unit is 45 minutes from the patient. The pilot is expressing concerns over taking this call due to the weather. Who has the final say when turning down a mission?

The flight team is flying an intubated and mechanically ventilated patient in ARDS. The patient has been in a refractory hypoxic state for the past 12 hours, with the highest SpO₂ reflecting 87%. The patient is currently on a FiO₂ of 0.30. They are flying at 10,000 feet MSL, with the atmospheric pressure at that altitude being 522 mmHg. Based on Dalton’s law, what would the partial pressure of oxygen be?

The flight team is transporting a pediatric patient in respiratory distress via fixed-wing aircraft. Their work of breathing has increased as they transition to level flight. According to Boyle’s law, what intervention might improve their respiratory status?

The intra-aortic balloon pump (IABP) begins to purge during ascent. The triggering mechanism is the result of which gas law?

The main disadvantage of pressure-limited ventilation is?

The patient has the following ABG results: pH 7.10, PaCO₂ 50, HCO3^– 24, PaO₂ 92, EtCO₂ 50, SpO₂ 92%.  You are attempting to manipulate the pH by increasing the patient’s minute ventilation (V_E) on the transport ventilator.  If you increase the V_E to reflect a decrease in EtCO₂ from 50 mmHg down to 30 mmHg, what would the change in pH reflect?

The patient is demonstrating a sudden increase in PIP; however, there is a normal Pplat. The most likely cause would be?

The primary trigger used for most intra-aortic balloon pump (IABP) operations is?

The priority post-crash, after a safe exit from the aircraft, is?

The proper shutdown procedure for most aeromedical aircraft would be in what priority?

The team is on the scene of a motor vehicle collision (MVC), where an 8-year-old patient is fully immobilized with apparent difficulty breathing. Assessment reveals circumoral cyanosis, diminished breath sounds throughout, and shallow chest expansion. SpO₂ is 89% on a non-rebreather. Due to the patient’s poor respiratory status, the decision is made to perform rapid sequence intubation (RSI) and continue fluid resuscitation. The patient is placed on the mechanical ventilator, and after approximately 10 minutes, they are demonstrating an increasing PIP, decreasing chest expansion, and decreasing pulse oximetry. The most appropriate action is to:

The team is caring for a neonate with limited prenatal care.  Which of the following signs would cause them to start immediate resuscitation?

The transport team is taking care of a 32-week post-conceptual age neonate with hyaline membrane disease. The patient is currently being ventilated on high-frequency oscillatory ventilation. The ventilator settings have been established as amplitude 25 cmH₂0, frequency 8 Hertz (Hz), mean airway pressure 8 cmH₂0, 40% FiO₂. After your assessment, you note that the chest oscillation has diminished.  What is the next best action?

The flight team has experienced a rotor-wing crash in a desolate mountainside and extreme weather.  The pilot is believed to be dead, and your partner is unresponsive.  The two biggest killers in the outdoors are:

This equation is used to identify what?

       [1.34 x Hgb x (SaO₂)] + PaO₂ x 0.003

What is a potential complication with surfactant replacement?

What is the emergency transmit frequency?

What is the most common cause for a patient to file a complaint against the transport team?

What is the new emergency transmit frequency that utilizes 800 MHz technology and satellite tracking?

What is the pitot tube on an aircraft used for?

What protective clothing does CAMTS require that is pertinent to safe operations?

What would be the anticipated findings in the early stages of septic shock?

What would be the best position for a neonate with myelomeningocele?

When applying pressure support (PS) in a neonate on SIMV, what is the stopping point for allowing the patient to take a spontaneous breath?

When checking P_plat, any pressure above ________ can cause ventilator lung injury (VLI) and possible barotrauma.

When transporting and assessing a patient with a pulmonary catheter, if the pulmonary artery diastolic pressure is more than 5 mmHg above the pulmonary capillary wedge pressure (PCWP), it signals which abnormal condition?

Which condition would result in a left shift on the oxyhemoglobin dissociation curve?

Which of the following will best increase the chance of survivability of the crew after a crash?

Which statement best describes Henry’s law?

With regards to a hypothermic neonate, shivering is limited by what?

You are transferring a 5-year-old pediatric trauma patient for emergent abdominal surgery. Which of the following would be considered an Emergency Medical Treatment and Labor Act (EMTALA) violation?

You are transporting a 7 kg infant who is being mechanically ventilated. Current SpO₂ is 89%. The patient is currently sedated, and lung sounds are noted to be diminished bilaterally in the lower lobes. Current ventilator settings are: SIMV 24, PC 7, Vte 43, FiO₂ 0.8, PEEP 4. Manipulating which setting would be MOST beneficial to increase the patient’s SpO₂?