Air Methods Critical Care Actual Exam– Air Methods Critical Care Transport Assessment – 2026/2027 Edition – Verified Questions and Answers | 100% correct

Air Methods Critical Care Actual Exam– Air Methods Critical Care Transport Assessment – 2026/2027 Edition – Verified Questions and Answers | 100% correct 1) The flight team is called to transport a patient diagnosed with pericarditis. It is reported that the patient has sharp chest pain and a pleural friction rub. Upon initial assessment, the pulses are diminished peripherally during inspiration, and return during exhalation. The most likely cause of this is: Aortic dissection Pericardial effusion Pulmonary embolism Tension pneumothorax Pericardial effusion Comments: A main complication of pericarditis is pericardial effusion. Typically pericarditis will present without paradoxical pulses (decreased pulses on inspiration). Paradoxical pulses, in conjunction with other supporting clinical signs like distended veins, muffled heart sounds, and hypotension should make the flight nurse suspect pericardial effusion has developed. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 310 2) Specialized transport methods in an isolette are especially important for neonates because isolettes provide specialized oxygen concentrations not available through traditional stretcher transport. neurodevelopmental complications can be caused by excessive vibration and noise. traditional flight teams do not regularly interact with neonates. specialty flight teams are covered by separate training and licensure that traditional flight teams do not carry. neurodevelopmental complications can be caused by excessive vibration and noise. Comments: Infants that are exposed to excessive noise and vibration are at risk for negative physiological responses, increased stress, and neurological damage. Isolettes alone do not provide specialized oxygen concentrations or pressurization. Licensure and training play a role in the need for a specialty team, but should not be a deciding factor for using an isolette. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 485 3) The team has arrived to transport a 5-year-old child who fell from a tree and has an open femur fracture, head trauma and a broken wrist. The child also has a decreased level of consciousness. IV access has been established by EMS and was tolerated without incident. Current vital signs are: BP 90/45 mmHgHR 165 beats/minRR 45 breaths/minO2 sat: 100% on room air The flight nurse should understand that: femur fractures are common injuries in the pediatric patient because they are prone to accidents. pediatric patients are likely to compensate longer than adults, and hypotension is a late indicator of shock. secondary IV access should be obtained since the child tolerated the first attempt without incident. pediatric patients are less likely to remain tachycardic after adequate resuscitation. pediatric patients are likely to compensate longer than adults, and hypotension is a late indicator of shock. Comments: Pediatric patients have sustained catecholamine responses and are likely to compensate longer than the adult population, however, when this response is depleted, they will rapidly decompensate. IV access should be irritating to a 5-year-old patient, and the patient tolerating the procedure should be considered as a sign of shock. Pediatric patients are more tachycardic at baseline and tachycardia is not an adequate indicator of fluid status. Femur fractures are rare injuries in children. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 533 4) The flight crew responds to the scene of a motor vehicle crash in which an unrestrained driver has been extricated from the vehicle. The patient is tachycardic, has a shortened and externally rotated leg, and is bleeding from the urethral meatus. The nurse suspects a posterior hip dislocation. pelvic fracture. crushed femoral head. kidney injury. pelvic fracture. Comments: A pelvic fracture can cause severe blood loss, resulting in hypotension and tachycardia. Assessment findings may include shortening of the affected leg, external rotation of the affected leg, and bleeding from the urethral meatus. A crushed femoral head may include shortening and external rotation of the affected leg; however, it is not likely to cause bleeding from the meatus. A posterior hip dislocation will not cause bleeding at the urethral meatus. A kidney injury may cause hematuria, but will not cause a shortened and externally rotated leg. _____Reference: Trauma Nursing Core Course, 8th ed., p. 148-149 5) The flight crew has arrived on scene to a mass shooting. Police on scene state that the shooter is not yet in custody. The PRIORITY assessment the team should make before rendering aid to victims is number of victims. police availability and presence. safety of the flight team. additional needed supplies. safety of the flight team. Comments: The safety of the flight team is the top priority for any disaster. The flight team cannot render aid if they are not safe. The other items are important, but not the most important. Rescuers should never be compromised in order to render aid. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 45 6) The nurse is called to transport a pediatric patient with seizures who is currently post-ictal. During transport, the nurse observes him becoming confused, diaphoretic, and jittery. The nurse should FIRST consider applying soft restraints. preparing to intubate. administering lorazepam (Ativan) IV push. checking the patient's blood glucose level. checking the patient's blood glucose level. Comments: Checking the patient's blood glucose level is what the nurse should consider first. Seizures can cause an increase in energy and burn glucose. Hypoglycemia can produce seizures in pediatric patients. Preparing to intubate is too much for the symptoms as they are presented. Soft restraints do not correct the issue of hypoglycemia. Administering lorazepam is not the first consideration because the symptoms indicate hypoglycemia. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 553 7) The flight crew is called to transport a patient who fell from approximately 20 feet. The patient was diagnosed with a subdural hematoma with a 5 mm shift. The patient is intubated and has the following ventilator settings and vital signs: Mode: SIMVFiO2 50%TV 350 mLRR 14 breaths/minPEEP 7 BP 195/90 mmHgHR 43 beats/minO2 sat 95%ETCO2: 40 mm Hg The flight nurse's IMMEDIATE intervention should be to change the: PEEP to 10 cm. FiO2 to 100%. tidal volume to 300 mL. respiratory rate to 20 breaths/min. respiratory rate to 20 breaths/min. Comments: Cushing's triad is indicative of increased intracranial pressure. Increasing the respiratory rate will decrease ETCO2, which can help decreased intracranial pressure until definitive treatment can be achieved. Changing the PEEP to 10 cm, tidal volume to 300 mL or the FiO2 to 100% will not help decrease intracranial pressure. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 194 8) A nurse is transporting an intubated child with pertussis who develops severe paroxysmal coughing. The oxygen saturation drops to 78% and the patient has a 20-second grand mal seizure. Which of the following should be administered at this time? racemic epinephrine (Asthmanefrin) endotracheal lidocaine (Xylocaine) fosphenytoin (Cerebyx) propofol (Diprivan) propofol (Diprivan) Comments: Propofol (Diprivan) should be administered. Pertussis is a bacterial infection often associated with a superimposed pneumonia. Management of all patients with pulmonary disease and ventilator asynchrony begins with sedation and analgesia to optimize ventilatory compliance. Racemic epinephrine (Asthmanefrin) should not be administered at this time. Racemic epinephrine is used for upper airway obstructions. The presence of a patent endotracheal tube assures the absence of upper airway obstruction. Fosphenytoin (Cerebyx) should not be administered at this time. While some patients with pertussis have seizures of unclear etiology, initial management of this patient is to restore oxygenation and ventilation. It is likely that the seizure is related to hypoxia in this case. Sedative agents also have anticonvulsant effects. Endotracheal lidocaine (Xylocaine) should not be administered at this time. Lidocaine (Xylocaine) is sometimes used by anesthesia providers for bronchospastic disease. The paroxysmal coughing in pertussis is not related to bronchospasm. ______Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th Edition (2018), p. 141, 1578 9) The nurse is transporting an adult patient who has a blood pressure of 82/40 mm Hg, heart rate of 130 beats/min, respiratory rate of 30 breaths/min and has an oxygen saturation of 95% on a nonrebreathing mask. The patient is moaning, skin is flushed with urticaria and wheezing is auscultated bilaterally. The nurse should suspect distributive shock. cardiogenic shock. obstructive shock. hypovolemic shock. distributive shock. Comments: While all forms of shock will cause hypotension, the scenario describes a patient who has the signs of an allergic reaction: urticaria and wheezing. Therefore, it is likely this patient is in anaphylactic shock, a form of distributive shock. There are no indications that this is cardiogenic or obstructive shock. Hypovolemic shock will present with hypotension and tachycardia; however, it is unlikely that there will be any cutaneous manifestations and wheezing as described in this scenario. These are findings consistent with anaphylactic shock. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 208 10) A patient requires transport for a hemorrhagic stroke. The patient is intubated and mechanically ventilated with a blood pressure of 225/100 mm Hg. Which of the following is the MOST appropriate target blood pressure? 100/75 mm Hg 180/100 mm Hg 140/85 mm Hg 160/95 mm Hg 140/85 mm Hg Comments: For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe (Class I; Level of Evidence A) and can be effective for improving functional outcome (Class IIa; Level of Evidence B). _____Reference: J.C. Hemphil, Greenberg, S.M., et al. (2015). Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 46: 11) The nurse responds to the scene of a sporting event. The patient is abnormally tall, has long arms and is complaining of burning chest pain. Lung sounds are clear and there is no jugular vein distention. Vital signs are as follows: BP: 230/140 mmHgHR: 109 beats/minRR: 30 breaths/minO2 sat: 96% (room air) The PRIORITY action for the nurse is to place nitroglycerin paste (Nitro-Bid). administer fentanyl (Duragesic). start an esmolol (Brevibloc) infusion. initiate a fluid bolus. start an esmolol (Brevibloc) infusion. Comments: The patient likely has Marfan syndrome and is experiencing an aortic dissection. The treatment is aggressive blood pressure and heart rate management with a beta-blocker and rapid transport to a surgical center. While management should include fentanyl, it is not the priority intervention. Fluids should be avoided. Nitroglycerin (Nitro-Bid) is not the first-line agent for aortic dissection. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 311 12) While preparing to intubate a 120kg patient, the flight nurse recognizes that preoxygenation is less effective in bariatric patients. To maximize chances for first pass success without hypoxia, the nurse should place the patient in a reverse Trendelenburg position. decrease the dose of paralytic used for induction. insert an orogastric tube before intubating. administer a 250ml normal saline bolus prior to induction. place the patient in a reverse Trendelenburg position. Comments: Because of the declining functional capacity due to size, lung volume is lost in patients who lie flat. Therefore "ramping" or reverse Trendelenburg position is encouraged during preoxygenation and intubation if sitting up is contraindicated. A fluid bolus may be needed for hemodynamics prior to RSI, but does not improve chances for successful intubation. An orogastric tube should be placed after intubation. A bariatric patient will likely need a higher dose of a paralytic to achieve adequate paralysis. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 260 13) A woman who is 33 weeks pregnant and has hypertension presents in established labor. Which signs and symptoms indicate that emergent cesarean section is required? BP 162/87 mm Hg, premature rupture of membranes, temperature 102.6°F (39.2°C), fetal heart rate 136 to 158 beats/min. BP 222/180 mm Hg, headache, fetal heart rate 128 to 150 beats/min. BP 101/67 mm Hg, vaginal bleeding, late decelerations, fetal heart rate 98 to 138 beats/min. BP 102/54 mm Hg, RR 8 breaths/min, lethargy, fetal heart rate 120 to 134 beats/min. BP 101/67 mm Hg, vaginal bleeding, late decelerations, fetal heart rate 98 to 138 beats/min. Comments: A BP of 101/67, vaginal bleeding, late decelerations, and fetal heart rate between 98 to 138 beats/min indicates an emergent cesarean section is required. Blood pressure is low for a pregnant patient at 33 weeks gestation. She has vaginal bleeding suggesting limited oxygen supply to fetus. Fetal distress as evidenced by late decelerations and fetal heart rate between 98 - 138. Immediate delivery is indicated. 222/180: Blood pressure is high. Fetus is not distressed. Management is with medication/expectant management. 162/87: Blood pressure is high and mother has a fever. There is no sign of fetal distress. Management is with medication/expectant management. 102/54: Blood pressure is low for a pregnant patient at 33 weeks gestation and needs to be managed with IVF and medications. There is no sign of fetal distress. _____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 374-375 14) Fluid resuscitation for a patient in profound hemorrhagic shock should include isotonic crystalloid solutions, followed by O-negative blood. fresh frozen plasma. platelets. isotonic bolus. O-negative blood. Comments: Group O blood should be supplied first in extreme emergencies. Rhesus D-negative blood should be supplied to all women of childbearing age. Type specific (ABO, Rh, D-matched) blood should be available within 5 minutes and the switch should be made promptly in order to not deplete stores of group O blood. Continue transfusing blood on this basis until time is available to crossmatch with the original serum sample. If a transport program administers blood in transport, they do not carry type-specific blood because O-negative is the universal donor. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 223 15) A 4-month-old infant is being transferred to a trauma center. The parent reported that the infant fell down a flight of stairs. The infant is intubated, comatose, and exhibiting signs of seizure activity. The transport nurse should suspect Reye's syndrome. infant neglect. Asperger's syndrome. non-accidental injury. non-accidental injury. Comments: The nurse should suspect a non-accidental injury because a 4-month-old infant does not have the ability to walk or crawl. The other options are not indicated by the parent's report. _____Reference: Wong's Nursing Care of Infants and Children, 11th Ed. (2019), p. 343 16) A 49-year-old patient complains of chest pain during transport. The 12 lead ECG reveals ST elevation in all 12 leads. The flight nurse suspects this is a STEMI imposter due to left bundle branch block. hyperkalemia. digoxin toxicity. pericarditis. pericarditis. Comments: The hallmark of acute pericarditis is widespread ST-segment elevation. A right bundle branch block will result in ST elevation in V1, and hyperkalemia will present with peaked T waves. Digoxin toxicity can lead to a number of dysrhythmias but not widespread ST elevation. _____Reference: Ismail T. F. (2020). Acute pericarditis: Update on diagnosis and management. Clinical medicine (London, England), 20(1), 48-51. 17) In a forward-facing seat without shoulder belts, which position is BEST in an emergency landing? Sitting upright with knees together and feet 6 inches apart. Sitting upright with the head held against the seat head rest and the arms in an X across the chest. Bending forward at the waist and encircling the knees with the arms. Holding the arms across the chest, forming an X with the forearms and grasping the shoulder harness. Bending forward at the waist and encircling the knees with the arms. Comments: In an emergency or precautionary landing situation, in which a hard landing may be anticipated, flight crew members should assume the survival position before impact. They should sit upright with the knees together and feet approximately 6 inches apart. In forward-facing seats equipped with shoulder belts, one should hold the arms across the chest, forming an X with the forearms and grasping the shoulder harness. In forward-facing seats without shoulder belts, one should bend forward at the waist and encircle the knees with the arms. In aft-facing seats, one should sit upright with the head held against the seat head rest and the arms in an X across the chest. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 110 18) The flight crew is en route to a hazmat scene. The nurse knows that a patient should be decontaminated before transferring patient care. landing at the receiving facility. being loaded into the aircraft. the aircrew lands at the scene. being loaded into the aircraft. Comments: The patient should be decontaminated before being placed in an enclosed space with the flight crew. This will limit the crew's exposure. The flight suit offers the lowest level of protection. While decontamination can take place before the flight crew arrives this is not required for a safe landing. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 47 19) A transport nurse should determine that a patient with chlorine gas exposure is appropriately treated when respiratory distress resolves. there is no hematuria. hypersalivation ceases. the skin pH is greater than 7.35. respiratory distress resolves. Comments: At high exposure levels, irritation of the upper respiratory tract and accumulation of fluid in the lungs (pulmonary edema) contribute to wheezing, cough, and dyspnea. Acute lung injury and/or ARDS can result in severe cases. Because this gas is primarily reactive only at a local level, absorbed systemic effects are not commonly observed. Skin pH measures are not a good measure of skin decontamination. Hypersalivation is a cholinergic toxidrome and is not associated with chlorine gas exposure. _____Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th Edition (2018), p. 732-733 20) In which of the following activities is it MOST important for the transport nurse to participate? safety briefing equipment check weather assessment daily base duties safety briefing Comments: A safety briefing held towards the beginning of the shift covers aspects of other options listed. It is meant to discuss work load for the day, assign roles and responsibilities, and discuss special situations relating to mission operation and safety for the shift. Although all are important, a safety briefing contributes the most to safety and crew resource management. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 106 21) The flight nurse observes that a patient receiving mechanical ventilation has developed worsening COPD. Ventilator settings are as follows: Mode: volume controlRate 16 breaths/minTidal volume 500 mLI:E 1:1FiO2 60%PEEP 5 cm H2OIdeal body weight: 65 kg The MOST appropriate action for the nurse to take is to: decrease the FiO2 to 30%. change the tidal volume to 600 mL. change the I:E ratio to 1:3. increase the FiO2 to 100%. change the I:E ratio to 1:3. Comments: The patient with an obstructive disease pathway benefits from longer exhalation times and lower volumes. The volume should be 6-8 ml/kg. While FiO2 can make a difference, I:E is the primary setting change that should occur. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 192 22) The flight nurse arrives on scene of an accident where the patient fell 20 feet. Vital signs are as follows: BP 80/40 mmHgHR 55 beats/minRR 24 breaths/min (shallow)O2 sat: 93% on a nonrebreathing mask The nurse should recognize that the PRIORITY medication to administer is atropine. norepinephrine (Levophed). morphine. dexamethasone (Ozurdex). norepinephrine (Levophed). Comments: The patient has lost vascular tone due to a probable spinal cord injury, and is in neurogenic shock. The priority is not pain management. Steroids are not indicated. Atropine is not the appropriate medication for neurogenic shock. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 208 23) A child with congenital hydrocephalus has a ventriculoperitoneal shunt in place. The FIRST sign of shunt displacement and malfunction is persistent vomiting. focal seizures. unconsciousness. general irritability. general irritability. Comments: The first sign of shunt displacement is general irritability. In most cases of shunt malfunction, the diagnosis is obvious because of the overt signs of elevated intracranial pressure including: headaches, vomiting, and lethargy. This mode of presentation occurs in approximately 70% of shunted children. The other 30% may present with more subtle signs of deterioration with neuropsychologic, cognitive, and behavioral symptoms heralding their shunt dysfunction. _____Reference: Wong's Nursing Care of Infants and Children, 11th Ed. (2019), 1163 24) A patient with atrial fibrillation complains of a sudden onset of pain and numbness in the right forearm. The arm is cool to the touch and has a thready radial pulse. The transport nurse should suspect which of the following? arterial thrombus myocardial ischemia venous insufficiency compartment syndrome arterial thrombus Comments: The nurse should suspect arterial thrombus. Arterial thrombus is a common complication of atrial fibrillation. An embolus which mobilizes into the upper extremities would manifest itself with these findings. Venous insufficiency is most commonly associated with the lower extremities and is a chronic condition. Classic findings include venous ulcers, skin discoloration, and enlarged or varicose veins. Compartment syndrome is an acute finding generally associated with trauma. Long bone fractures are present in as much as 70% of all patients presenting with compartment syndrome. Other causes such as drug abuse, anticoagulant use, and other chronic medical conditions have also been associated with compartment syndrome. Myocardial ischemia is commonly manifested with pain radiating to the left arm and neck, and does not usually cause vascular changes to the upper extremities. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 305 25) The flight nurse is called to transport a patient diagnosed with seizures. Upon arrival, referring staff states the patient has had 4 tonic-clonic seizures in the last hour. As the nurse begins their assessment, the patient suffers an additional tonic-clonic seizure lasting approximately 45 seconds. They are now obtunded, with snoring respirations. The primary intervention for this patient is: Administration of Romazicon (flumazenil) Insertion of an oropharyngeal airway Rapid sequence intubation Administration of Keppra (levetiracetam) Rapid sequence intubation Comments: Rapid sequence intubation (RSI) is indicated at this point in the patient's hospitalization due to prolonged hypoxia to tissue cells related to multiple seizures, unresponsive presentation, and inability to maintain a patent airway. Maintaining a patent airway is the main intervention for this patient during transport. This patient should be treated aggressively with benzodiazepines and anti-epileptic medications, however, RSI is the primary intervention. Administering Romazicon is contraindicated and could induce seizures. Inserting an OPA could cause the patient to gag and does not provide a definitive airway. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 295 26) The flight team arrives to transport a child from a community emergency department to a pediatric center. The child is sitting in a tripod position and coughing. The chest X-ray reveals steeple sign. The nurses NEXT action should be to administer methylprednisolone (SolumMEDROL). racemic epinephrine albuterol (Proventil HFA). dexamethasone (Decadron). racemic epinephrine Comments: Racemic epinephrine is the treatment for croup. Steroids are indicated but should not be the first intervention. ______Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 505 27) The flight crew responds to a structure fire. A firefighter has been overcome with smoke and pulled out of the building by his colleagues. He complains of headache and dizziness. His initial vital signs are: BP: 120/80 mmHg HR: 120 beats/min RR: 22 breaths/min O2 Sat: 100% (room air) The MOST appropriate intervention is: Obtain capillary blood glucose level 15 liters/min oxygen via non-rebreather mask 500 mL lactated Ringers solution 2.5 mg Proventil (Albuterol) via nebulizer 15 liters/min oxygen via non-rebreather mask Comments: Hypemic hypoxia can result from carbon monoxide poisoning. Carbon monoxide is a result of incomplete combustion and is present in any fire or smoke situation. It binds with hemoglobin 200 times more readily than oxygen and can lead to artificially high SpO2 levels. The treatment for this condition is administration of high flow oxygen. While the patient is tachycardic, his blood pressure is normal and there is no indication for fluid bolus. The history does not give an indication for albuterol. A fingerstick blood glucose is not the priority due to the mechanism of injury. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 30 28) A pediatric trauma patient goes into cardiac arrest on scene, and the decision is made to transport them to the nearest trauma center by ground for compassionate reasons. The flight nurse turns the care of the patient over to the basic life support unit and returns with the helicopter. This is an example of abandonment. battery. malfeasance. vicarious liability. abandonment. Comments: Unilateral termination of the nurse-patient relationship without consent defines abandonment of a patient. Additionally, when a patient is transferred to someone less qualified, abandonment can occur. Vicarious liability is defined as one party being responsible for the actions of another. Battery is the touching of a person without his or her consent. Malfeasance is a breach of duty occurring as the result of an act of commission. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 575 29) In management of a motor vehicle accident, who should be in charge of the scene? logistics administration operations planning operations Comments: Operations will oversee the staging manager, EMS, fire and law branches. Logistics, planning and administration report to the operations liaison. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 46 30) The flight nurse notes that noise from the aircraft has caused a 70-year-old patient who is being mechanically ventilated to become agitated. Which of the following should the nurse administer for further sedation? ketamine (Ketalar) midazolam (Versed) lorazepam (Ativan) rocuronium (Esmeron) ketamine (Ketalar) Comments: Elderly patients can have paradoxical excitation with benzodiazepines and caution should be used. A paralytic is not indicated in this situation. Ketamine can provide a safer alternative for sedation. _____Reference: Sheehy's Manual of Emergency Care, 7th Edition (2013), p. 584 31) The flight team is called to transport a 5-year-old, 20 kilogram trauma patient status post intra abdominal wound repair with drain placement. The patient has two JP drains to the lower abdomen, each with 10ml of sanguineous fluid. The patient is intubated and has received 0.5mg of midazolam, and 25mcg of Fentanyl approximately 20 minutes prior to arrival and is not compliant with the ventilator. Vitals signs:BP: 84/36 mmHgHR: 145 beats/minRR: 28 breaths/minO2 Sat: 100% (70% FiO2) The MOST likely cause of the patient's tachycardia is: Inadequate sedation Internal hemorrhage Sepsis Medication reaction Inadequate sedation Comments: Pediatric patient's require high levels of sedation to adequately maintain pain control and sedation. The dosages provided may not be enough medication for a child with traumatic injury. Internal hemorrhage is possible, but with drains in place there would be more evidence of bleeding. Sepsis can cause tachycardia, but would likely not present this early after intervention. Tachycardia is not a sole indicator of a medication reaction. Other clinical signs should be considered such as hives, rash, and fever. _____Reference: Wong's Nursing Care of Infants and Children, 11th Ed. (2019), p. 140, 152 32) The flight nurse called to transport a 7-year-old child with urosepsis. Vital signs are as follows: BP: 75/35 mmHgHR: 145 beats/minRR: 35 breaths/minT (rectal): 104F (40C)O2 Sat: 100% (room air) The child is pale, diaphoretic, and lethargic. The flight nurse recognizes that: hypotension in children is a late sign of shock. tachypnea is not a reliable indicator of shock since the SPO2 is normal. skin assessment is a reliable indicator of temperature management in children. slow administration of fluid will ensure the patient does not become fluid overloaded. hypotension in children is a late sign of shock. Comments: Children are able to compensate in shock states by increasing HR, SVR, and venous tone, and therefore hypotension is a late indicator of shock because it indicates that compensatory mechanisms have been depleted. Skin assessment is important as an indicator of perfusion status, not of temperature. Aggressive fluid administration should be initiated due to the decompensated state of shock. Worsening tachypnea can lead to exhaustion in children and should be monitored closely despite SPO2 as the shock state worsens. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 549 33) The flight nurse is called to an accident scene where a patient has been trapped under a fallen tree for several hours and has a crushed leg. IV access has been established. As the patient is extracted, the nurse should prepare to administer fentanyl (Duragesic). normal saline. calcium gluconate. magnesium chloride. calcium gluconate. Comments: Crush injuries can cause a large release of potassium. Calcium gluconate is used to neutralize the effects of hyperkalemia. Fentanyl can be given after or before for pain control but is not the priority. Normal saline can be given for volume replacement but is again not the priority. Magnesium chloride would not be a correct choice for this patient. _____Reference: Sheehy's Emergency Nursing: Principles and Practice, 7th Edition (2019), p. 199 34) In a helicopter safety and landing zone (LZ) presentation to a local EMS service, which of the following is the MOST important instruction for EMS personnel? Utilize ambulance lights to highlight the LZ. Approach only from the loading side of the helicopter. Ensure LZ is at least 200' x 200'. Proceed toward the aircraft only when directed by the pilot. Proceed toward the aircraft only when directed by the pilot .Comments: The EMS scene call environment is one of the most potentially hazardous aspects of air medical operations. Safety is of paramount importance and situational awareness must be maintained when working around an aircraft. Ground personnel should only be allowed to approach the aircraft when directed to do so by the pilot or a flight crew member. The pilot in command of the aircraft must be able to see personnel approaching. Mitigating the hazard from air medical operations on ground personnel is the most important instruction. The LZ can be a minimum of 100' x 100'. While some situations may require lighting the landing zone, the MOST important instruction for EMS personnel should be to approach only when directed. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 105-106 35) When postpartum hemorrhage is identified, the transport nurse should immediately massage the fundus. perform bimanual uterine compression. administer magnesium sulfate. place the patient in the Trendelenburg position. massage the fundus. Comments: The transport nurse should immediately massage the fundus. Fundal massage in the setting of postpartum hemorrhage causes the uterine muscles to contract and this greatly decreases bleeding. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 445 36) During radio transmission of a patient report, the flight nurse should remain brief, speaking clearly and concisely. verbalize head-to-toe assessment findings. release the microphone at every pause. relay the patient's name and date of birth. massage the fundus. Comments: The transport nurse should immediately massage the fundus. Fundal massage in the setting of postpartum hemorrhage causes the uterine muscles to contract and this greatly decreases bleeding. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 445 37) A patient is 33 weeks pregnant and reports headaches, visual changes, pain in the right upper abdominal quadrant, nausea and dizziness. She has proteinuria, and results of laboratory studies are as follows: Hematocrit 29.3% Hemoglobin 10.1 g/dL Platelets 38,400/mm3 BUN 48 mg/dL Creatinine level 1.2 mg/dL AST 137 U/L ALT 122 U/L Bilirubin 1.2 mg/dL What pregnancy-related condition should the transport nurse suspect? preeclampsia eclampsia HELLP syndrome pregnancy-induced hypertension HELLP syndrome Comments: The transport nurse should suspect HELLP syndrome. The lab values give a textbook definition of hemolysis, elevated liver enzymes, low-platelet count (HELLP). _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 457 38) The flight crew is transporting a patient diagnosed with a saddle pulmonary embolism. The nurse knows that which is true about mechanical ventilation and perfusion for this patient? ETCO2 is a reliable indicator of perfusion status in this patient. ETCO2 should be solely utilized to make ventilator titrations. ETCO2 will be higher than PaCO2 due to decreased dead space. ETCO2 will be unpredictably lower than PaCO2 due to decreased perfusion of alveoli ETCO2 will be unpredictably lower than PaCO2 due to decreased perfusion of alveoli Comments: Due to increased dead space and decreased perfusion to the alveoli, ETCO2 will be lower than PaCO2 and as perfusion worsens, this gradient will widen. ETCO2 will never be higher than PaCO2, and is not a reliable indicator of perfusion status in these patients due to the compromised ventilation status. PaCO2 is the gold standard for ventilator decisions. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 195 39) Following initiation of bag-mask ventilation of a preterm neonate, the oxygen saturation remains 88% and cyanosis persists. Auscultation reveals bowel sounds on the left side of the chest and a scaphoid abdomen. The nurse should suspect diaphragmatic hernia. an omphalocele. umbilical hernia. a perforated bowel. diaphragmatic hernia. Comments: A diaphragmatic hernia is a defect in the diaphragm allowing herniation of the abdominal contents to migrate in to the thoracic cavity causing low oxygen saturations due to decreased space for the lung to expand fully, auscultation of bowel sounds on the affected side of the chest, and a scaphoid abdomen. Bowel sounds in the chest cavity and a scaphoid abdomen are classic signs of a diaphragmatic hernia. An omphalocele is a birth defect where the infant is born with its intestines on the outside of its body. A perforated bowel would present with a distended, tender, and firm abdomen with possible fever. An umbilical hernia is an area of weakness or disruption of the abdominal wall around the umbilicus through which intra abdominal structures can potentially pass through causing localized swelling and possibly pain. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 482 40) The best method to reduce risk in transition of care is having physician rounds while giving report. a case presentation format. sidebar discussions. a consistent format. a consistent format. Comments: A consistent format ensures continuity of care and minimizes human error. A physician does not need to be present for transition of care between nurses. Sidebar conversations can be distracting and enhance rather than reduce risk during turnover. _____Reference: Trauma Nursing: From Resuscitation Through Rehabilitation, 5th Ed. (2019), p. 88 Single choice 41) The flight crew has been requested for an interfacility transport of an elderly patient who is awake, alert, and alone. After assessment, there are no life-threatening conditions, and the patient insists on not being transported. The patient states their child manages their finances and only allots them a certain amount of money each month. The patient is concerned they will not be able to afford the transport due to these financial concerns. The appropriate action for the flight crew is to: Question the patient about abuse and transport the patient without consent Report suspected elderly abuse and honor the patient's wishes Contact family for consent and provide information on social services Reassure the patient that Medicare with cover the cost for transport Report suspected elderly abuse and honor the patient's wishes Comments: Consent is required prior to transport. It is estimated that 1 in 10 older adults experience abuse or neglect. Visits related to healthcare may be the only human interaction outside of the caregiver. Fear of retribution and isolation often prevent the elderly from report abuse. According to the CDC there are 6 types of abuse, physical, sexual, emotional, neglect, abandonment, and financial. Health care provider are mandated reports. In this case, the patient is describing the potential for financial abuse and requires further intervention by the flight crew. _____Reference: Transport Professional Advanced Trauma Course, 6th Ed. (2018), p. 30; Trauma Nursing Core Course, 8th ed., p. 308 42) The nurse is transporting a patient with a lower gastrointestinal bleed who is alert but anxious. The patient has cool, clammy skin with significant pallor of the mucous membranes. The patient received one liter of normal saline by local EMS upon arrival to the ED. Vital signs are as follows: BP 78/42 mm Hg HR 132 beats/min RR 32 breaths/min Temp 97.0º F (36.1 Cº) What is the highest priority intervention for this patient? nasogastric tube insertion rapid sequence intubation initiation of packed red blood cells initiation of vasopressors initiation of packed red blood cells Comments: The highest priority intervention is the initiation of packed red blood cells. The patient is presenting with fluid refractory hypovolemic shock and the highest priority is to restore the oxygen-carrying capacity of the blood. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 368 43) The team is at a scene where a 3-year-old boy has been injured in an all-terrain vehicle crash. The patient is crying loudly. Assessment reveals pallor, tachypnea, and tachycardia. He also has abdominal distention, multiple abrasions, and a deformity to the right thigh. Oxygen is administered, and an IV with a bolus of normal saline solution is initiated. The next MOST appropriate action is to initiate intubation. clean and apply dressings to the abrasions. insert a gastric tube. administer blood. administer blood. Comments: Insertion of a nasogastric tube is not indicated at this time. Abdominal distention is likely due to intra-abdominal hemorrhage based on mechanism of injury and other findings. Administration of blood is indicated in a pediatric trauma patient if clinical condition has not improved after 20 mL/kg of crystalloids has been infused. There is no indication for intubation at this time, as the patient appears to have a patent airway. Cleaning and applying dressings to the abrasions may be done; however, is it not the most appropriate action based on the scenario. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 550 44) A patient in a motor vehicle crash has a seatbelt bruise across their upper abdomen. The patient has hypotension and tachycardia after receiving 2 L of crystalloid IV fluid. Which of the following should the transport nurse administer FIRST? norepinephrine hypertonic saline tranexamic acid packed red blood cells packed red blood cells Comments: The transport nurse should first administer packed red blood cells. Restoring intravascular volume and oxygen-carrying capacity is the highest priority. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 134 45) The flight team responds to a facility for a high risk OB transport of a mother with gestational diabetes. The baby has just been delivered and is born limp. A heel stick reveals a blood glucose of 25 mg/dL and an umbilical line has been placed by the delivery team. Appropriate treatment is to administer: D10W 4 - 6 mg/kg/min D5W 1 - 2 mg/kg/min D50 0.5 - 1 ml/kg IV push D25 2 - 4 ml/kg IV push D10W 4 - 6 mg/kg/min Comments: Critically ill hypoglycemic neonates require IV glucose infusions of 4-6 mg/kg/min of D10W. The other doses and concentrations are not appropriate for this age group. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 474 46) An infant with dehydration and sepsis is being transported for admission to the ICU. Which of the following findings would indicate the need for further fluid resuscitation? tachycardia urine output of 2 mL/kg/hr flat fontanelle apneic episodes tachycardia Comments: Tachycardia is an early sign of hypovolemia. Infants can only increase cardiac output by increasing heart rate. They cannot increase stroke volume. A flat fontanelle is incorrect because in a dehydrated infant the fontanelle would be sunken rather than flat. A flat fontanelle is a normal finding. A urine output here is incorrect because a urine output of 2 mL/kg/hr indicates normal fluid volume status. Apneic episodes are incorrect because apneic episodes are not an indication of volume depletion. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 524 47) Treatment for acute decompression illness includes which of the following? positive pressure ventilation rapid descent 250 mg acetazolamide (Diamox) slow IV push climb back to an acceptable altitude rapid descent Comments: Rapid descent along with 100% oxygen is the initial treatment for acute decompression illness. 250 mg acetazolamide (Diamox) slow IV push is the treatment for acute mountain sickness. It is not a treatment for acute decompression illness. Climbing back to an acceptable altitude is used for barodontalgia or ear block and not acute decompression illness. Positive pressure ventilation would not have any effect on the cause of acute decompression illness. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 41 48) The flight team arrives at the bedside of a patient diagnosed with septic shock who is being transferred for higher level of care. The patient has received two 30 ml/kg fluid boluses of normal saline and has been started on norepinephrine at 10 mcg/minute, resulting in a normotensive blood pressure. The patient's initial lactate level was 8 mmol/L and a recent redraw indicates that it is now 7.5 mmol/L. The flight nurse should consider initiating: Dopamine 5 mcg/kg/min IV Epinephrine 0.2 mcg/kg/min IV Dobutamine 2 mcg/kg/min IV Phenylephrine 0.5 mcg/kg/min IV Dobutamine 2 mcg/kg/min IV Comments: In the setting of septic shock, if the lactate level does not decrease by at least 10% despite fluid resuscitation and vasopressor administration, then a positive inotropic agent should be added. If the patient requires blood pressure and inotropic support then epinephrine alone can be used in lieu of norepinephrine and dobutamine, but that is not indicated in this scenario. The other two options are not indicated. _____Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th Edition (2018), p. 75 49) A transport nurse is caring for a patient with inhalation burns and surface burns to the chest and face. The nurse should provide volume resuscitation based on maintaining the MAP no lower than 65 mm Hg. the Modified Brooke formula for maintenance fluid. urine output of 30 mL/hr. the Parkland Formula for the surface burns. urine output of 30 mL/hr. Comments: The inhalation component of the burn makes calculation of fluid needs complex because it is difficult to understand the extent of internal tissue damage. Urine output is a measure of systemic resuscitation that can guide volume administration. A MAP of 65 is a good target in early goal-directed sepsis therapy but is not a recognized target for resuscitation in burn patients. While the Parkland Formula is appropriate for the surface burns, it will likely underestimate the fluid needs. The Modified Brooke calculates only maintenance fluid needs. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 282 50) A patient who ingested ethylene glycol is being transported by air to a tertiary care center that offers specialized services for hemodialysis. They are placed on a ventilator with the following settings: Mode SIMV Rate 28 breaths/min PEEP 5 cm H20 FiO2 100% En route, arterial blood gas measurements are as follows:pH 7.01PaCO2 30 mm HgPaO2 181 mm HgBase excess 5 mEq/LHCO3- 5 mEq/L The patient has a respiratory rate of 38 breaths/min, most likely because they are compensating for: metabolic acidosis. metabolic alkalosis. respiratory acidosis. respiratory alkalosis. metabolic acidosis. Comments: The patient is most likely compensating for metabolic acidosis. Ethylene glycol ingestion leads to intoxication similar to ethanol ingestion. A profound anion gap metabolic acidosis is a hallmark of this poisoning, but it only occurs after metabolism has begun. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 424 51) The flight nurse is transporting a patient with thoracic trauma. The nurse should recognize that a late sign of hypoxia in this patient is rapid respiratory rate. decreased oxygen saturation. cyanosis. use of accessory muscles. cyanosis. Comments: Cyanosis is a late finding of hypoxia due to thoracic trauma, and its absence is not a reliable indicator of adequate oxygenation. Low SpO2 is the defining characteristic of hypoxia. Rapid respiratory rate and accessory muscle use are early signs of hypoxia. _____Reference: Trauma Nursing: From Resuscitation Through Rehabilitation, 5th Ed. (2019), p. 504 52) The flight team responds to a scene call for a patient that was lost in a mountainous region overnight. The patient presents with delayed capillary refill, despite having a normal heart rate and blood pressure. The flight nurse suspects that this is a result of: hypothermia. hypoglycemia. hyperkalemia. hypercapnia. hypothermia. Comments: Delayed capillary refill identifies poor distal perfusion and is the result of inadequate perfusion pressure or hypothermia. Delayed capillary refill is not a sign of hypoglycemia, hyperkalemia, or hypercapnia. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 129 53) When intubating a pediatric patient, BEST practice is to use which type of endotracheal tube and place the child in which position? uncuffed, neutral uncuffed, flexed cuffed, flexed cuffed, neutral cuffed, neutral Comments: The standard of care is a cuffed tube for all ages if available for intubation. Because of the large size of the child's head, a towel should be placed under the shoulders to allow for a neutral position. Having the neck flexed can obstruct the airway. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 496 54) The transport team is transporting an unresponsive patient that had sustained a significant blow to the head. The patient was intubated prior to transport. The ETCO2 was initially 38 mm Hg. The patient is now bradycardic with a widening of the pulse pressure. Which of the following interventions should the transport nurse do at this time? Increase the rate of fluid replacement. Provide sedation. Increase the rate on the ventilator. Administer atropine.v Increase the rate on the ventilator. Comments: The nurse should increase the rate on the ventilator. The patient is showing signs of herniation. It is appropriate to increase the rate on the ventilator to hyperventilate to ultimately decrease intracranial pressure. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 195 55) The flight team is called to the scene of an industrial accident where a worker was electrocuted by a live wire. The electrolyte imbalance that would cause the MOST concern is sodium. potassium. calcium. magnesium. potassium. Comments: Electrical burns pose a risk to kidney function because they are associated with rhabdomyolysis and elevated myoglobin levels. Without adequate kidney function, potassium levels will increase and pose a threat to cardiac regularity. _____Reference: Critical Care Nursing: Diagnosis & Management, 8th Ed. (2018), p. 850 56) A patient is being transported after falling from a standing height. The referral hospital reports they had a brief loss of consciousness, and the family reports more memory loss than usual. A CT scan has been obtained. What is the MOST likely finding? subarachnoid hemorrhage epidural hematoma cerebral contusion subdural hematoma cerebral contusion Comments: The most likely finding is a cerebral contusion, often occurring in adults with traumatic brain injury and appears as a decreased density on CT scan. An epidural hematoma is not the most likely finding. The hemorrhage pattern is lenticular as the blood follows the outer layer of dura and is limited by suture lines. A collection of blood between the inner layer of the dura mater and the arachnoid mater, a subdural hematoma appears as blood following the inner layer of the dura mater and is not limited by suture lines. It often is crescent shaped. A collection of blood between the arachnoid mater and pia mater (brain surface), a subarachnoid hemorrhage is generally occupied by connective tissue and cerebrospinal fluid. A subarachnoid hemorrhage can lead to hydrocephalus and increased intracranial pressure, and often has a hydrocephalus appearance with blood trapped along the gyri and sulci of the brain surface. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 234 57) The flight nurse is called to the scene of a motor vehicle accident where the patient was found pinned beneath the steering wheel. Upon initial assessment, the patient has well-perfused upper extremities, mottling below the umbilicus, and decreased pedal pulses. The flight nurse knows this patient is likely suffering from: Traumatic aortic dissection Pulmonary embolism Open book pelvis Abdominal compartment syndrome Traumatic aortic dissection Comments: Aortic disruption presents with mismatched pulses in the upper and lower extremities, hypertension in the upper extremities, and poor perfusion to the lower extremities. Abdominal compartment syndrome, open book pelvic fractures, and pulmonary embolism do not present with mismatched pulses. Abdominal compartment syndrome typically occurs several hours after the initial injury and is rarely present on a scene flight. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 254 58) The flight team is transporting a patient on dialysis who has an infected arteriovenous shunt. The patient requires rapid sequence intubation en route. The flight nurse knows which of the following medications is contraindicated as an induction agent? versed (Midazolam) ketamine (Ketalar) succinylcholine (Anectine) rocuronium (Zemuron) succinylcholine (Anectine) Comments: Succinylcholine is a depolarizing medication. It can cause an increase in potassium. The patient is already likely to have an increased potassium level due to having kidney failure. The other medications would not cause this increase in potassium. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 175 59) Upon reaching altitude, the endotracheal cuff pressure reads 32 cm of H20. Which of the following actions, if any, is required? No intervention is required. Replace the endotracheal tube. Inflate the cuff slightly. Deflate the cuff slightly. Deflate the cuff slightly. Comments: Deflating the cuff slightly is correct because the recommended ETT cuff pressure is 20-30 cm H20 . Higher pressures may cause complications such as mucosal damage and tracheal ischemia. Replacing the end of the endotracheal tube is incorrect because there is no indication that the ETT is not functioning properly. Inflating the cuff slightly is incorrect because the current cuff pressure already exceeds what is recommended. No intervention is incorrect because the current cuff pressure exceeds what is recommended. Therefore, the cuff should be deflated slightly to avoid complications. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 165 60) The flight nurse is called for an interfacility transport of a patient who is receiving hemodialysis and has missed the last 3 appointments. The nurse arrives to find the patient in the tripod position and taking shallow breaths. IV access has been established. The NEXT intervention should be to administer nitroglycerin. administer 1L of a normal saline bolus. prepare for intubation. obtain an arterial blood gas sample. administer nitroglycerin. Comments: The patient is likely fluid overloaded. While intubation might be needed, giving a medication like nitroglycerin will reduce preload and pulmonary edema. A fluid bolus would be contraindicated. A blood gas could be helpful but should not be the priority intervention. _____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 171 61) A transport nurse is preparing a pediatric trauma patient for a 45-minute fixed-wing flight to a tertiary care hospital. The patient's mother has requested that she be allowed to accompany her child on the flight. Which of the following is the MOST important factor that the transport nurse must consider when evaluating the request? The aircraft does not have another passenger seat available. The weather for the flight is predicted to be marginal. The mother states she has a history of motion sickness. The mother appears to be extremely anxious. The aircraft does not have another passenger seat available. Comments: Safety for the entire team is the primary factor on which to base the decision regarding family members accompanying patients on transports. If the aircraft does not have a passenger seat with a seat belt for the mother, she may not accompany the patient in the aircraft. A history of motion sickness is a valid concern when evaluating family members' requests to accompany patients on transports, but it is not the highest priority. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 581 62) A patient with an unstable pelvis was found 6 hours after falling down a ravine and is being evacuated from the scene via helicopter. They were placed on oxygen at 6 L/min via nasal cannula and have the following vital signs: BP 80/45 mm Hg HR 98 beats/min RR 32 breaths/min 02 Sat 100% ETCO2 22 mm Hg The flight nurse recognizes this patient is MOST likely suffering from: anaerobic metabolism. permissive hypotension. neurogenic shock. pulmonary contusion. anaerobic metabolism Comments: The low ETCO2 value coupled with vital signs consistent with shock are indicative of a patient in anaerobic metabolism. Neurogenic shock is incorrect because in neurogenic shock bradycardia would be expected. Permissive hypotension is incorrect because there is no indication of an intentional choice to not resuscitate the patient. Pulmonary contusion is incorrect because with a pulmonary contusion it is unlikely the oxygen saturation would be 100% on 6 L. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 198-203 63) The flight crew is transporting a patient with a femur facture via interfacility transfer. The flight nurse received report from the nurse that the patient was treated with two doses of IV narcotics and one dose IV benzodiazepines, which are documented appropriately on the MAR. The patient is alert and oriented, reporting pain at 10 out 10 and is adamant that no pain medications have been administered. The flight nurse should treat the assessed pain level and: Assess the patient for a history of substance abuse Confront the nurse for the ineffective pain control Explain to the patient that long bone fractures are painful and distracting which contributed to missing the administration Report the flight crews' concerns of possible diversion to the hospital supervisor Report the flight crews' concerns of possible diversion to the hospital supervisor Comments: Per the Joint Commission, "Appropriate response for staff can be summarized as 'see something, say something.' At the institutional level, appropriate responses include establishing a just culture in which reporting drug diversion is encouraged, assessing harm to patients, consulting with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies." _____Reference: /media/tjc/newsletters/quick_safety_drug_diversion_ 64) While transporting a pregnant patient in preterm labor, the transport nurse notes fetal bradycardia and finds a prolapsed umbilical cord. Initial intervention should include supine maternal positioning. attempted replacement of the umbilical cord. discontinuing tocolytic administration. manual displacement of the presenting part. manual displacement of the presenting part. Comments: Elevation of the presenting part with a hand in the vagina is done to prevent further cord compression. Positioning in Trendelenburg or the knee-chest position can also be attempted. Supine maternal positioning will not help and may additionally cause maternal hypotension due to supine hypotension syndrome. Attempted replacement of the umbilical cord would be dangerous. Although the cord may spontaneously retract, the cord should never be manually replaced because severe compression may occur. Tocolysis is indicated to slow contractions and reduce the pressure on the cord. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 449 65) During transport of a patient on mechanical ventilation who is sedated and chemically paralyzed, the transport nurse notes the following ETCO2 waveform. Which of the following is the MOST likely cause of this finding? bronchospasm the development of auto-PEEP incomplete chemical paralysis partial obstruction of the ventilator circuit incomplete chemical paralysis Comments: The most likely cause of this finding is incomplete chemical paralysis. The "curare cleft" may be seen in patients who are regaining muscle use after chemical paralysis. Partial obstruction of the ventilator circuit, auto-PEEP, or bronchospasms would prolong the rising phase 2-3 of the waveform and may cause a "shark fin" appearance. _____Reference: Rosen's Emergency Medicine: Concepts & Clinical Practice, 9th Edition (2018), p.62 66) While looking at the chest radiograph of an adult patient, a transport nurse notes that the tip of the ETT is 3 cm above the carina. The MOST appropriate action is to maintain current position. reintubate the patient. advance tube 2 cm. pull tube back 3 cm. maintain current position. Comments: Maintaining current position of the endotracheal tube in this situation is indicated as the tube is optimally positioned when at 3 - 5 cm above the carina (bifurcation of the trachea into the left and right main bronchi). _____Reference: Marino's The Little ICU Book, 2nd Edition (2016), p. 373-375 A transport nurse is caring for a patient with a temporary pacemaker in place. The settings are as follows: Rate: 70 beats/min Output: 20mA Sensitivity: 3mV Mode: VVI Decrease the sensitivity to 1.0 mV Comments: The ECG strip demonstrates undersensing. The sensitivity is too high in this instance at 3.0mV meaning if the pacemaker does not sense a native stimulus that is 3.0mV, it is going to elicit a stimulus from the pacemaker. For reference, each small vertical block on the ECG is 0.1mV. This is causing a situation that is similar to asynchronous pacing, which when there is native electrical activity, the R-on-T phenomenon leading to ventricular fibrillation may occur if the stimulus hits on the back half of the T wave. The sensitivity number should be "decreased" which translates to a "more sensitive" setting whereas it can "sense" lower stimuluses that have lower mV, and hence see more native electrical activity. This in turn would correlate with demand pacing where if the pacemaker does see native electrical activity, it will not fire; conversely, if it doesn't see a native electrical stimulus from the patients heart, it will fire more appropriately. If the pacemaker rate is increased to 80, this potentially dangerous situation will happen with increased frequency. Increasing the output to 30mA is not physically possible with the pacemaker generators that are available on the market today. The upper limits for output are 20-25 mA depending on the model and manufacturer. Transcutaneous pacing mA can go much higher, typically over 100mA. Decreasing the mA to 10mA will not change what is happening here. _____Reference: AACN Procedure Manual for High Acuity, Prog