CRITICAL CARE TRANSPORT CERTIFICATION – QUESTIONS AND ANSWERS
Core Domains
* Advanced Airway Management
* Hemodynamic Monitoring and Support
* Neurological Assessment and Critical Care
* Mechanical Ventilation Principles
* Pharmacology in Critical Care Transport
* Trauma and Burn Management
* Ethical and Legal Considerations
* Aerospace Physiology and Physics
Introduction
*The purpose of this examination is to evaluate the proficiency of transport clinicians
SECTION ONE: QUESTIONS 1–100
1. A patient with a traumatic brain injury is being transported. You note the end-tidal
CO2 (EtCO2) has dropped from 38 mmHg to 25 mmHg. What is the most likely
cause?
, A. Hypoventilation
B. Hyperventilation
C. Decreased cardiac output
D. Increased metabolic rate
🟢B
🔴 RATIONALE: Hyperventilation leads to decreased levels of CO2 in the blood
and expired air, as the patient is exhaling more CO2 than is being produced.
2. Which of the following is a primary concern regarding the use of succinylcholine in
a patient with a crush injury occurring 48 hours ago?
A. Malignant hyperthermia
B. Hyperkalemia
C. Anaphylaxis
D. Hypotension
🟢B
🔴 RATIONALE: Crush injuries and extensive muscle damage can cause up-
regulation of acetylcholine receptors, leading to significant potassium release upon
succinylcholine administration.
3. During fixed-wing flight, which law explains why an unvented middle ear may cause
pain as altitude increases?
A. Dalton's Law
B. Henry's Law
C. Boyle's Law
, D. Graham's Law
🟢C
🔴 RATIONALE: Boyle’s Law states that the volume of a gas is inversely
proportional to the pressure exerted on it. As ambient pressure decreases at
altitude, trapped gases expand.
4. You are managing a patient on a mechanical ventilator. Which parameter is the
most direct indicator of adequate ventilation?
A. PaO2
B. SaO2
C. EtCO2
D. HCO3
🟢C
🔴 RATIONALE: While PaO2 measures oxygenation, EtCO2 is the most direct
non-invasive measurement of ventilation adequacy at the bedside.
5. A patient with an intra-aortic balloon pump (IABP) becomes tachycardic. How does
this affect the pump's effectiveness?
A. It increases diastolic augmentation time
B. It decreases the systolic unloading effect
C. It decreases the diastolic filling time for the balloon
D. It improves myocardial oxygen supply
🟢C
, 🔴 RATIONALE: Tachycardia reduces the time spent in diastole, which is when the
IABP must inflate to augment coronary perfusion, thereby reducing its efficacy.
6. Which medication is the preferred sedative for a patient with hemodynamic
instability during rapid sequence intubation?
A. Propofol
B. Etomidate
C. Midazolam
D. Ketamine
🟢B
🔴 RATIONALE: Etomidate is hemodynamically neutral, making it the preferred
agent for induction in patients at risk of hypotension.
7. A patient with a chest tube is being transported by air. What must be done to the
drainage system?
A. Keep it at the same level as the patient
B. Secure the chest tube to the patient's clothing
C. Ensure the system is vented to prevent pressure buildup
D. Clamp the tube during takeoff and landing
🟢C
🔴 RATIONALE: Changes in cabin pressure require the drainage system to remain
vented to prevent tension pneumothorax due to gas expansion as per Boyle's Law.
Core Domains
* Advanced Airway Management
* Hemodynamic Monitoring and Support
* Neurological Assessment and Critical Care
* Mechanical Ventilation Principles
* Pharmacology in Critical Care Transport
* Trauma and Burn Management
* Ethical and Legal Considerations
* Aerospace Physiology and Physics
Introduction
*The purpose of this examination is to evaluate the proficiency of transport clinicians
SECTION ONE: QUESTIONS 1–100
1. A patient with a traumatic brain injury is being transported. You note the end-tidal
CO2 (EtCO2) has dropped from 38 mmHg to 25 mmHg. What is the most likely
cause?
, A. Hypoventilation
B. Hyperventilation
C. Decreased cardiac output
D. Increased metabolic rate
🟢B
🔴 RATIONALE: Hyperventilation leads to decreased levels of CO2 in the blood
and expired air, as the patient is exhaling more CO2 than is being produced.
2. Which of the following is a primary concern regarding the use of succinylcholine in
a patient with a crush injury occurring 48 hours ago?
A. Malignant hyperthermia
B. Hyperkalemia
C. Anaphylaxis
D. Hypotension
🟢B
🔴 RATIONALE: Crush injuries and extensive muscle damage can cause up-
regulation of acetylcholine receptors, leading to significant potassium release upon
succinylcholine administration.
3. During fixed-wing flight, which law explains why an unvented middle ear may cause
pain as altitude increases?
A. Dalton's Law
B. Henry's Law
C. Boyle's Law
, D. Graham's Law
🟢C
🔴 RATIONALE: Boyle’s Law states that the volume of a gas is inversely
proportional to the pressure exerted on it. As ambient pressure decreases at
altitude, trapped gases expand.
4. You are managing a patient on a mechanical ventilator. Which parameter is the
most direct indicator of adequate ventilation?
A. PaO2
B. SaO2
C. EtCO2
D. HCO3
🟢C
🔴 RATIONALE: While PaO2 measures oxygenation, EtCO2 is the most direct
non-invasive measurement of ventilation adequacy at the bedside.
5. A patient with an intra-aortic balloon pump (IABP) becomes tachycardic. How does
this affect the pump's effectiveness?
A. It increases diastolic augmentation time
B. It decreases the systolic unloading effect
C. It decreases the diastolic filling time for the balloon
D. It improves myocardial oxygen supply
🟢C
, 🔴 RATIONALE: Tachycardia reduces the time spent in diastole, which is when the
IABP must inflate to augment coronary perfusion, thereby reducing its efficacy.
6. Which medication is the preferred sedative for a patient with hemodynamic
instability during rapid sequence intubation?
A. Propofol
B. Etomidate
C. Midazolam
D. Ketamine
🟢B
🔴 RATIONALE: Etomidate is hemodynamically neutral, making it the preferred
agent for induction in patients at risk of hypotension.
7. A patient with a chest tube is being transported by air. What must be done to the
drainage system?
A. Keep it at the same level as the patient
B. Secure the chest tube to the patient's clothing
C. Ensure the system is vented to prevent pressure buildup
D. Clamp the tube during takeoff and landing
🟢C
🔴 RATIONALE: Changes in cabin pressure require the drainage system to remain
vented to prevent tension pneumothorax due to gas expansion as per Boyle's Law.
