General Principles
Which of the following actions should a nurse take to transport a patient who has a hyphema?
Apply an ice pack.
Administer ketorolate.
Patch the affected eye.
Elevate the head to a 30 degree angle.
Elevate the head to a 30 degree angle.
Comments: The nurse should elevate the patient's head to a 30° angle to decrease intraocular pressure. _____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 555
The nurse arrives to a rural hospital to transport a patient who has been involved in a motor vehicle collision. Upon arrival, the patient is awake, and complains of abdominal pain and left shoulder pain. Vitals signs are:
BP: 85/48 mmHg
HR: 118 beats/min
RR: 26 breaths/min
O2 Sat: 100% (15L non-rebreather mask)
Pain: 8/10
Initial resuscitation of this patient should begin with:
Tranexamic acid (TXA)
Sublimaze (Fentanyl)
Packed red blood cells
Normal saline
Packed red blood cells
Comments: This patient is presenting with Kehr's sign, which is indicative of splenic injury and blood in the peritoneal cavity. They are hypotensive and tachycardic. Initial resuscitation should begin with blood administration, followed by platelets, plasma, and cryoprecipitate if available. While the pain may need to be addressed, replacing lost blood products takes priority. TXA should be initiated after blood product resuscitation. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 205
A patient that presented to a rural facility suffered a stab wound to the neck at the level of C4. The airway is patent and the knife has been left in place. The priority intervention for the transport of this patient is:
Apply a cervical collar and place the knife in a paper bag as evidence.
Leave the knife in place unless neurological function declines
Remove the knife and apply direct pressure
Leave the knife securely in place and stabilize it
Leave the knife securely in place and stabilize it
Comments: The priority intervention for transporting a patient with a penetrating object is immobilization and stabilization of the weapon. Removal of the penetrating weapon could make it difficult to determine the track of the wound at the receiving hospital. It is not appropriate to remove the weapon as this could cause more damage to the area. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 235
A flight team is dispatched to transport a patient with circumferential full-thickness burns to the chest. The patient is intubated and placed on a ventilator. The flight nurse notes the peak inspiratory pressure to be 45 cm H2O. Which of the following is the BEST intervention for this finding?
Place bilateral tube thoracostomies.
Switch the mode to pressure control.
Perform escharotomies to the thorax.
Attempt to suction the patient.
Perform escharotomies to the thorax.
Comments: Due to the loss of elasticity of the tissue following a burn, it may become difficult to ventilate a patient. Performing escharotomies will enable effective ventilation. Although suctioning the patient may help with oxygenation, it will not change the lung compliance. As this is a burn patient with bilateral breath sounds, a tube thoracotomy is not indicated at this point. Changing the mode to pressure control will not change the decreased lung compliance caused by the circumferential burns to the chest. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 282
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
Asperger's syndrome.
infant neglect.
Reye'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
While taking report on a patient in a metabolic acidosis, the referring nurse mentions that the patient’s pH is 7.15. The flight nurse recognizes that this indicates that:
The risk of pulmonary embolism is increased
Oxygen delivery at the tissue level is increased
The SpO2 will read higher for a given PaO2
The patient’s respiratory rate will slow to compensate
Oxygen delivery at the tissue level is increased
Comments: Decreasing pH leads to a right shift in the oxyhemoglobin disassociation curve. This decreases hemoglobin's affinity for oxygen, leading to elevated delivery at the tissue level. The SpO2 would read lower with a right shift. The respiratory rate should increase to compensate for the acidosis. Clotting factors are less active in the presence of acidosis, so the risk for PE is decreased. _____Reference: Critical Care Nursing: Diagnosis & Management, 8th Ed. (2018), p. 438
The flight team is transporting a patient with a subarachnoid hemorrhage to a tertiary facility for neurosurgical consult. Management priorities during transport include:
Administering osmotic diuretics if the patient develops a newly fixed and dilated pupil
Administering Rocuronium if the patient requires rapid sequence intubation
Routine hyperventilation to maintain ETCO2 20-25
Systolic blood pressure goal of 70-80 mmHg
Administering osmotic diuretics if the patient develops a newly fixed and dilated pupil
Comments: Osmotic diuretics (hypertonic saline and Mannitol) are indicated to manage acute neurologic changes due to suspected increasing intracranial pressure, such as a newly dilated pupil, new onset hemiparesis, or a new loss of consciousness. Hyperventilation causes cerebral vasoconstriction, which decreases cerebral perfusion. Hypotension worsens cerebral perfusion. Long-acting paralytics mask seizure activity for an extended period. _____Reference: Advanced Trauma Life Support Student Course Manual, 10th Ed (2018), p. 119-122
The flight crew is transporting a patient with acute stroke who presented to the ED with a one hour onset of the following symptoms: aphasia, right sided hemisensory loss, and a left sided gaze deviation. Based on this presentation, the flight nurse recognizes that the thrombus can be localized to which area of the brain?
Brainstem
Right hemisphere
Cerebellum
Left hemisphere
Left hemisphere
The left hemisphere of the brain controls movement and sensation to the right side of the body. It also controls the language in most people. Right side hemisphere strokes are associated with left hemisphere-inattention or neglect, left hemiparesis, left hemisensory loss, and a right sided gaze. Patients with brain stem strokes will present with crossed signs of hemiparesis/ hemisensory loss or quadriparesis. Cerebellum strokes are associated with ipsilateral symptoms and ataxia.
Reference: Advance Stroke Life Support, 11 ed. Hospital and Prehospital Instructor Manual, Chapter 5
A school-age patient presents after a house fire with 3rd degree circumferential burns of the neck and chest. Physical exam reveals the extent of the burn is 60% total body surface area. The patient also presents with stridor and drooling. Vital signs are:
BP: 90/45 mmHg
HR: 133 beats/min
RR: 28 breaths/min
O2 Sat: 100% (room air)
GCS: 14
The flight nurse understands that the PRIORITY intervention is:
Administration of IV fluids
Wound debridement
Application of dry sterile dressings
Rapid sequence intubation
Rapid sequence intubation
Comments: The patient is demonstrating signs and symptoms of smoke inhalation and younger patients are at greater risk for airway obstruction. Oxygen saturation may be inaccurate due to carbon monoxide exposure from an enclosed area. The priority intervention is to protect the airway and initiate early intubation. IV fluids, dressings, and wound debridement are all indicated for burn resuscitation, but they are not the priority. _____Reference: Advanced Trauma Life Support Student Course Manual, 10th Ed (2018), p. 171
The flight team is called to transport an elderly patient who has a subdural hematoma. The nurse recognizes symptom onset and progression is typically slower because elderly patients
often take medications that slow heart rate and lower blood pressure.
tend to seek treatment earlier after injury than younger patients.
frequently have increased clotting factors.
have more potential space for the hematoma to expand.
have more potential space for the hematoma to expand.
Comments: Cerebral atrophy allows for more swelling and bleeding to take place without effect in elderly patients. Medications that slow the heart rate and lower blood pressure do not necessarily decrease the progression of a subdural hematoma. Symptom onset and progression is unrelated to when a patient seeks treatment. An increase in clotting factors is not related to the progression of a subdural hematoma. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 232
The flight nurse is transporting a patient from the sending hospital to the airport in an ambulance. The EMT asks what PPE they should wear for the patient. The patient is diagnosed with Influenza and is receiving mechanical ventilation. The EMT should wear:
surgical mask, gloves, gown, eye protection
N-95 Mask, gloves, gown
N-95 mask, gown, gloves, eye protection
surgical mask, gloves, eye protection
N-95 mask, gown, gloves, eye protection
Comments: The required PPE for an aerosolized respiratory pathogen should be an N-95 mask, gown, gloves and eye protection. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 391
Oxygen saturation is 86% with high flow oxygen via nonrebreathing mask on a patient with pulmonary contusions from blunt chest trauma. The next intervention should be
fluid resuscitation.
nasotracheal suctioning.
administration of an opiate.
positive pressure ventilation.
positive pressure ventilation.
Comments: Positive pressure ventilation, either noninvasive or invasive, is indicated to improve oxygenation in a pulmonary contused patient. Fluids will not improve oxygenation and neither will pain medication or suctioning of the nonintubated patient be likely to improve the patient's hypoxia. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 250
A 15-year-old patient presents after a motor vehicle crash with rib fractures, pain with breathing, and an oxygen saturation of 94% on oxygen at 2 L/min via nasal cannula. The nurse knows the patient needs to be monitored for a
flail chest.
hemothorax.
ruptured diaphragm.
pulmonary contusion.
pulmonary contusion.
The nurse is caring for a patient who was assaulted with a baseball bat. The patient was struck multiple times in the right flank and back and ecchymosis is noted on bilateral flanks. Vital signs are:
BP: 78/45 mmHg (56 MAP)
HR: 140 beats/min
RR: 38 breaths/min
SpO2: 92% (4L nasal canula)
The nurse would question the use of which diagnostic/assessment tool?
Exploratory laparotomy
CT abdomen and pelvis
FAST exam
Diagnostic peritoneal aspiration
CT abdomen and pelvis
Comments: Ecchymosis of the flanks (grey-turner sign) is indicative of retroperitoneal bleeding following blunt trauma. The patient's vital signs indicate they are too unstable for CT scan. A skilled clinician may be able to evaluate injury to the flank using a FAST exam. Diagnostic peritoneal aspiration may be utilized to assess for internal bleeding. An exploratory laparotomy may be indicated in some instances. _____Reference: Bloom BA, Gibbons RC. Focused Assessment with Sonography for Trauma. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470479/
The flight crew is dispatched to the scene of a high-speed motor vehicle collision. On arrival, the flight crew receives a 32-week pregnant patient supine in the back of an ambulance. The patient is awake and alert, complaining of low back pain. On assessment, the nurse palpates the fundal height at the costal margins, uterine rigidity, and dark red vaginal bleeding is noted. Based on this assessment, the nurse suspects which of the following?
Ovarian laceration
Uterine rupture
Abruptio placentae
Placenta previa
Abruptio placentae
Comments: Classic signs and symptoms of abruptio placentae are dark red vaginal bleeding, a board-like uterus, and a rising fundal height (at 32 weeks, the fundus should be between the umbilicus and costal margins). Patients with placenta previa will present with painless, bright red bleeding. The classic sign of a uterine rupture is an asymmetric uterus and patients with an ovarian laceration will present with signs and symptoms of retroperitoneal bleeding. _____Reference: Trauma Nursing Core Course, 9th ed. (2024), p. 355-356
Pulmonary embolism is suspected in a mechanically ventilated patient with acute oxygen desaturation with which of the following?
Decreased end tidal CO2 values
Dramatically elevated Peak Inspiratory Pressure
Bradycardia
Unilateral breath sounds
Decreased end tidal CO2 values
Comments: Pulmonary embolism is an acute lung perfusion problem that does not impact ventilation. The lungs get adequate air flow, but blood flow is impaired. End tidal CO2 values would be expected to drop due to an increase in the amount of dead space (lung tissue that is ventilated but not perfused). Decreased end tidal CO2 values and unilateral breath sounds suggest tension pneumothorax. Bradycardia is rarely seen in pulmonary embolism and may be a very late sign. _____Reference: Pilbeam’s Mechanical Ventilation, 6th Edition (2015), P. 317, 346
The flight nurse evaluates adequate gas exchange of a patient with carbon monoxide poisoning by the use of
pulse oximetry.
ETCO2.
carboxyhemoglobin level.
PaO2.
PaO2.
A patient suffers facial trauma during a fall. On the initial assessment by the flight crew, the patient complains of diplopia. The assessment finding is concerning for which of the following?
Basilar skull fracture
Linear skull fracture
Le Fort III fracture
Mandibular fracture
Le Fort III fracture
Comments: Le Fort III fractures involve complete craniofacial separation leading to massive facial edema, mobility and depression of the zygomatic bones, periorbital ecchymoses, and diplopia. On assessment, patients with mandibular fractures may have malocclusion of the jaw, facial asymmetry, palpable step off deformity, and drooling. Assessment findings following a linear skull fracture may include headache, soft tissue injury, and possible decreased loss of consciousness. Assessment findings following a basilar skull fracture may include hearing loss, CSF in rhinorrhea or otorrhea, Battle's sign, hemotympanum, and facial nerve palsy. _____Reference: Trauma Nursing Core Course, 8th ed., chapter 6
The flight team is requested to transport a 43-year-old patient to a referral center 60 minutes away. Upon arrival bedside, the RN reports no urine output for four hours. Creatinine has increased from 1.3mg/dL to 2.3 mg/dL. Ventilator FiO2 is being increased to 100%; Positive end-expiratory pressure (PEEP) is 10 cm H2O.
BP 85/70 mmHg
Intra-aortic balloon pump (IABP) 1:1 ratio
Augmented IABP pressure 100 mmHg
Mean arterial pressure 82 mmHg
ABG
pH 7.15
PaCO2 54 mmHg
PaO2 58 mmHg
HCO3 16 mmol/L
Base excess -12
O2 Saturation 88%
What should the flight nurse do PRIOR to transporting this patient?
Contact the sending physician
Consider an alternate mode of ventilation
Decrease the PEEP to 5 cm H2O
Request a milrinone (Primacor) infusion
Contact the sending physician
Comments: The patient's declining into multi-system organ failure. Mean arterial pressure is satisfactory on the IABP. However, the patient's oxygenation status is deteriorating. Ventilator FiO2 is now at 100%. A call to the sending & accepting MD is warranted. Treatment plans discussed originally may be changed based on this new data. The patient's oxygenation status is paramount, and the MD's need to be made aware. If the plan was made to escalate mechanical circulatory support, this is something that takes time to implement. Providing an alternate form of ventilation and adding milrinone are temporary measures which also may be incorporated, but the oxygenation status needs to be addressed. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 18-26, 198-213, 298-332
The flight nurse is assessing fetal heart tones during transport. The heart rate is noted to be 170 beats/min. Fifteen minutes later, the heart rate is noted to be 175 beats/min. The flight nurse's NEXT action should be to:
Prepare for imminent delivery
Administer a magnesium bolus
Re-assess in 15 minutes
Administer an IV fluid bolus
Administer an IV fluid bolus
Comments: The normal fetal heart rate is 110-160 beats/min. Persistent tachycardia or bradycardia could be a sign of fetal distress. Tachycardia could be from either the mother or fetus. These causes could include smoking, maternal fever, anemia, hypovolemia, fetal tachydysrhythmia and maternal hyperthyroidism. Initial treatment can include placing the mother on the left side, as well as administering supplemental oxygen and IV fluid boluses. Calling for further orders by an OB or maternal medicine specialist is also advised.
_____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p.439
Mechanical noninvasive positive pressure ventilation (NPPV) is MOST successful in patients with:
Upper airway obstruction
Hemodynamic instability
Pulmonary embolism
COPD exacerbation
COPD exacerbation
Comments: The strongest evidence of support for the successful use of NPPV is in patients with acute exacerbation of COPD and acute cardiogenic pulmonary edema. NPPV is contraindicated in patients with hemodynamic instability, upper airway obstruction, unstable arrhythmia, and cardiac or respiratory arrest. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 242
The flight nurse is preparing to transport a patient with a suspected arterial gas embolism. The nurse should arrange to transport the patient
with endotracheal intubation and on 100% oxygen.
using an inspired helium and oxygen mixture.
after the administration of 0.1 gm/kg of methylene blue.
in a manner that requires under 1,000 feet of altitude change.
in a manner that requires under 1,000 feet of altitude change.
Comments: Transporting a patient with an arterial gas embolism requires that the minimum safe altitude rule be applied and an altitude change of less than 1000 ft would be applicable. This principle follows Boyle's Law where an increase in altitude results in a decrease in atmospheric barometric pressure and the subsequent increase/expansion of air within an enclosed body. _____Reference: Critical Care Transport Core Curriculum (2017), p. 16
A patient has sustained significant facial trauma from impact with the steering wheel during a collision. Assessment at the scene reveals significant soft-tissue swelling, periorbital, and facial asymmetry with malocclusion. On gentle palpation, the patient's face is mobile and there is increased bleeding from the lacerations. Based on these findings, the nurse suspects
Le Fort I fracture.
fracture of the maxilla.
Le Fort III fracture.
fracture of the mandible.
Le Fort III fracture.
Comments: The nurse should suspect a Le Fort III: craniofacial disjunction. Complete separation of the cranial attachments from the facial bones which causes the face to be free floating when assessed. Le Fort II: pyramidal fracture involving the mid face. It involves a triangular segment of the mid-portion of the face and nasal bones. It does not cause free floating of the face. Mandible fracture is a fracture of the jaw bone. It can be unilateral or bilateral. It does not cause free floating of the face. Maxilla fracture is a fracture of the upper jaw bone, as well as, part of the nasal bone and eye socket. It is very similar to a Le Fort II fracture. However, a Le Fort II is bilateral whereas a maxilla fracture is unilateral. _____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 561-562
The nurse is called to transport a patient who was found running around a music festival after ingesting an unknown substance. The patient is restrained in 4 points and is thrashing on the bed. The immediate intervention is:
Inform the pilot the patient is too agitated to fly and you must go by ground.
Administer diphenhydramine (Benadryl)
Administer succinylcholine (Anectine)
Administer midazolam (Versed)
Administer midazolam (Versed)
Comments: Crew safety is the priority when patient's are presenting with hyperactivity or delirium. This hyperactivity is best treated with benzodiazepines. This patient is too delirious for redirection and will not be adequately calmed down for a flight and presents a risk to become agitated again during flight. Benadryl is not a first line treatment for delirium. Succinylcholine may provide temporary control but is not a recommended standard of a care for acute delirium. Going by ground does not negate the issue of the patient being agitated and unsafe to the crew. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 423
On scene, a 2 year old is reported to be unconscious secondary to foreign body aspiration. Using a laryngoscope, the transport nurse notes a coin just below the glottis. The nurse should
use Magill forceps to remove the coin.
immediately perform cricothyrotomy.
use the ET tube to push the coin into a mainstem bronchus.
place an oropharyngeal airway and ventilate the patient.
use Magill forceps to remove the coin.
Comments: The nurse should use Magill forceps. If the foreign body can be visualized with a laryngoscopy, then an attempt to remove it should be made. The other options are to be tried after this attempt. If the attempt to remove the item fails and the object is near the glottis, the nurse should perform a needle cricothyrotomy. _____Reference: ASTNA Patient Transport: Principles and Practice, 5th Ed. (2018), p. 506