AIR METHODS CRITICAL CARE EXAM – FLIGHT &
CRITICAL CARE TRANSPORT | COMPLETE EXAM
QUESTIONS WITH DETAILED SOLUTIONS.
INTRODUCTION
This package is designed for Air Methods clinical staff (flight paramedics, nurses, and respiratory
therapists) preparing for the company's internal Critical Care Exam. The 100 questions are based on Air
Methods' clinical guidelines, protocols, and Scope of Practice, focusing on the unique aspects of critical
care transport in the air medical environment. Content covers high-altitude physiology, advanced
hemodynamic monitoring (IABP, Impella, Swan-Ganz), ventilator management in flight, advanced
pharmacology (vasoactive drips, sedation, paralytics), blood product administration, managing specialized
equipment (e.g., LUCAS, ventilators), and scene/ICU-to-aircraft transitions for complex patients.
QUESTIONS (100 TOTAL).
1. During the ascent phase of a helicopter transport with a patient on a propofol infusion for sedation, the
flight crew notes a sudden decrease in the patient's blood pressure. The patient is intubated and
mechanically ventilated. What is the MOST likely contributing physiological factor, and what is the priority
intervention?
A. Hypoxia; increase FiO2 to 100%
B. Expansion of trapped gas; increase PEEP
C. Decreased venous return due to reduced preload; consider a fluid bolus and/or decreasing the propofol
infusion rate
D. Increased afterload; start a nitroprusside infusion
Answer: C
Solution: The most likely factor is decreased preload due to gravity-dependent blood pooling in the lower
extremities during ascent, compounded by propofol's vasodilatory and negative inotropic effects. The
priority intervention is to address the hypotension by considering a judicious fluid bolus (if not
contraindicated by the patient's primary condition, e.g., CHF) and/or decreasing the propofol infusion rate
to mitigate its hemodynamic effects. Increasing FiO2 (A) addresses hypoxia, not hypotension from preload
reduction. Expansion of trapped gas (B) is a concern for pneumothorax but not the primary cause of this
specific hypotension. Increasing afterload (D) is opposite to the likely problem.
2. You are transporting a patient with an intra-aortic balloon pump (IABP) set on 1:1 augmentation. Upon
entering the aircraft, the IABP alarms, indicating "Loss of Augmentation." After confirming the patient's
ECG leads are intact and the waveform is adequate, what is the NEXT most critical step?
A. Switch the IABP to internal trigger mode.
B. Check the helium drive line and catheter for kinks or disconnection.
C. Deflate the balloon and transport without augmentation.
CRITICAL CARE TRANSPORT | COMPLETE EXAM
QUESTIONS WITH DETAILED SOLUTIONS.
INTRODUCTION
This package is designed for Air Methods clinical staff (flight paramedics, nurses, and respiratory
therapists) preparing for the company's internal Critical Care Exam. The 100 questions are based on Air
Methods' clinical guidelines, protocols, and Scope of Practice, focusing on the unique aspects of critical
care transport in the air medical environment. Content covers high-altitude physiology, advanced
hemodynamic monitoring (IABP, Impella, Swan-Ganz), ventilator management in flight, advanced
pharmacology (vasoactive drips, sedation, paralytics), blood product administration, managing specialized
equipment (e.g., LUCAS, ventilators), and scene/ICU-to-aircraft transitions for complex patients.
QUESTIONS (100 TOTAL).
1. During the ascent phase of a helicopter transport with a patient on a propofol infusion for sedation, the
flight crew notes a sudden decrease in the patient's blood pressure. The patient is intubated and
mechanically ventilated. What is the MOST likely contributing physiological factor, and what is the priority
intervention?
A. Hypoxia; increase FiO2 to 100%
B. Expansion of trapped gas; increase PEEP
C. Decreased venous return due to reduced preload; consider a fluid bolus and/or decreasing the propofol
infusion rate
D. Increased afterload; start a nitroprusside infusion
Answer: C
Solution: The most likely factor is decreased preload due to gravity-dependent blood pooling in the lower
extremities during ascent, compounded by propofol's vasodilatory and negative inotropic effects. The
priority intervention is to address the hypotension by considering a judicious fluid bolus (if not
contraindicated by the patient's primary condition, e.g., CHF) and/or decreasing the propofol infusion rate
to mitigate its hemodynamic effects. Increasing FiO2 (A) addresses hypoxia, not hypotension from preload
reduction. Expansion of trapped gas (B) is a concern for pneumothorax but not the primary cause of this
specific hypotension. Increasing afterload (D) is opposite to the likely problem.
2. You are transporting a patient with an intra-aortic balloon pump (IABP) set on 1:1 augmentation. Upon
entering the aircraft, the IABP alarms, indicating "Loss of Augmentation." After confirming the patient's
ECG leads are intact and the waveform is adequate, what is the NEXT most critical step?
A. Switch the IABP to internal trigger mode.
B. Check the helium drive line and catheter for kinks or disconnection.
C. Deflate the balloon and transport without augmentation.
