Neuro
A 20-year old male who has a traumatic brain injury, is intubated and has a continuous intercranial pressure monitor in place. He is sedated on propofol and fentanyl. While preparing him for transport, the ICP waveform is progressively rising. He is now awake, and his heart rate increased. You should
1) drain cerebral spinal fluid.
2) lie him flat on the stretcher.
3) increase his sedation.
4) administer a paralytic.
Increase his sedation.
The patient is suffering from increased intracranial pressure likely from the increased environmental stimuli caused by the flight crew preparing the patient for transport. Since the flight crew needs to continue their work to transport their patient, increasing the patient's sedation will limit his response to the environmental stimuli and decrease his intracranial pressure.
You are transporting a 63-year-old female who has a history of upper respiratory infection. She is intubated, sedated, and on a ventilator. During descent, her heart rate and blood pressure increase. You observe blood-tinged discharge from both of her ears. The most appropriate next course of action is
1) reascend aircraft and begin a slower descent.
2) administer an analgesic.
3) decrease tidal volume and PEEP on ventilator
4) perform a halo test on the discharge
Reascend aircraft and begin a slower descent
Patient is likely experiencing barotitis media as evidence by vital signs reflecting painful stimulus and discharge from ear. Reascent and then controlled descent is the most appropriate, lest invasive treatment.
In flight, a 67-year-old female begins complaining of severe chest pain radiating to the neck and left arm. She is awake, and complaining of nausea. Her vital signs are HR 160, RR 35, and BP 85/50. The ECG monitor reveals a wide complex tachycardia with HR of 160 and dissociated P waves. She is receiving oxygen by mask and a saline lock is in-place. Your next intervention should be
1) Synchronized cardioversion
2) Lidocaine 1 mg/kg IV
3) Utilize vagal manuevers
4) Verapamil 5 mg IV
Synchronized cardioversion
A 59-year-old male who has heart failure on NiPPV with setting of IPAP of 12 and EPAP of 7. Furosemide 80 mg IV has been administered and he remains alert and oriented. His vital signs are HR 82, RR 25, BP 190/110 and SpO2 is 94%. You should
1) repeat furosemide dose.
2) intubate before transport.
3) increase the IPAP
4) administer nitroglycerin
administer nitroglycerin
The patient is currently experiencing a CHF exacerbation with pulmonary edema. The patient has recieved Lasix and already is on Bipap. The patient is noted to be extremely hypertensive. While Lasix can help with vasodilation and fluid excretion, nitroglycerin should also be utilized to help decrease the BP and help decrease pulmonary edema.
A 13-month-old male has 9% TBSA extremity burns. He weighs 10 kg. He has a urinary catheter in place and has received fluid resuscitation. His urine output was 30 mL in the last hour. You should suspect
1) inadequate fluid resuscitation
2) excessive fluid resuscitation
3) adequate liver function
4) acute kidney injury
excessive fluid resuscitation
1.0-1.5 ml/kg/hr urinary output is considered a standard endpoint of resuscitation
A 24-year-old male who fell off a ladder earlier today has loss of fine touch and vibratory sensation on the right side of his body, and the inability to sense painful stimuli on the left side of his body. You should suspect
1) anterior cord syndrome
2) brown-sequared syndrome
3) posterior cord syndrome
4) central cord syndrome
Brown-sequard syndrome
Brown-sequard syndrome is characterized by ipsilateral paralysis and contralateral loss of pain.
You are caring for a patient who is being transferred to a higher level of care facility. In flight, the patient begins to become hypotensive, PIP increases on the ventilator, jugular vein distention is seen, and the patient has no breath sounds on the left side. You determine that the patient is developing a tension pneumothorax. Which law explains why this occurred?
1) Henr'ys Law
2) Gay-Lussac's Law
3) Fick's Law
4) Boyle's Law
Boyle's Law
In the majority of the population, which coronary artery is occluded in a myocardial infarction isolated to the right ventricle?
1) Left circumflex
2) Right coronary
3) Left anterior descending
4) Left coronary
Right coronary
A 35-year-old male self-extricated himself from inside the building fire at a plastics plant. He has nausea and vomiting, tachypnea, bradycardia, and hypotension. You should administer
1) hydroxocobalamin
2) atropine
3) epinephrine
4) tetracycline
hydroxocobalamin
A 39-year-old male with an electrical burn injury 24 hours ago requires transport to the closest burn center. The referral hospital has placed an indwelling catheter, two peripheral IVs and treated him with fluids. During the transport, his urine changes from yellow to dark tea color. You suspect he is developing acute
1) renal failure
2) respiratory acidosis
3) necrosis of blood vessels
4) liver failure
renal failure
Because the electrical current can travel deep into the skin, deep structures such as muscle, bone, tendons, blood vessels and nerves can be damaged. Massive muscle damage will lead to renal failure due to myoglobinuria if not adequately resuscitated.
A 34-year-old male was struck by a car. Bystanders report he was initially unconscious and quickly woke up. On your arrival, he is awake and alert communicating with you During transport, he becomes increasingly drowsy to lethargic. You should suspect
1) subarachnoid hematoma
2) subdural hematoma
3) epidural hematoma
4) intracranial hematoma
epidural hematoma
Epidural hematomas present with a history of brief unconsciousness, followed by a lucid period lasting for different lengths of time and then rapid deterioration.
What kind of hypoxia is the patient exposed to cyanide most likely to suffer from?
1) Hypemic hypoxia
2) Histotoxic hypoxia
3) Stagnant hypoxia
4) Hypoxic hypoxia
Histotoxic hypoxia
What is a contraindication for the use of IABP counter-pulsation therapy?
1) Cardiogenic shock
2) Myocardial infarction
3) Septic shock
4) Aortic insufficiency
Aortic insufficiency
The aortic valve must be competent or the balloon inflation with increase aortic regurgitation and increase cardiac work overloading the ventricle. The IABP may be used to treat the other diagnoses if heart failure develops.
Which of the following comprehensive metabolic profile disturbances may result as a normal part of the aging process?
1) Elevated blood urea nitrogen (BUN)
2) Elevated sodium
3) Elevated potassium
4) Elevated blood glucose
Elevated blood urea nitrogen (BUN)
Elderly patients may experience elevations in the BUN as a normal part of the aging process.
Blood glucose, sodium, and potassium levels do not change as a result of normal aging.
Your team responds to a scene where your five-year-old patient was a passenger in a high-speed auto crash. The patient is removed from the vehicle in their intact booster seat, they note the presence of a bruise across the patient's lower abdomen from the lap belt. For which of the following injuries should the medical transport crew be most suspicious?
1) Ruptured spleen
2) Avulsion to the liver
3) Rupture of the small intestine
4) Rupture of the bladder
Rupture of the small intestine
Which of the following will likely contribute to a secondary brain injury in a patient who has a TBI?
1) Hyperoxia
2) Permissive hypercapnia
3) Cerebral hypertenion
4) Hypotension
Hypotension
Hypotension is devastating to a head injury patient. It robs the brain of vital oxygen and nutrients. Hypotension after the initial insult can lead to secondary brain injury.
A patient with a tension pneumothorax would experience which type of hypoxia?
1) Histotoxic hypoxia
2) Hypemic hypoxia
3) Stagnant hypoxia
4) Hypoxic hypoxia
Stagnant hypoxia
A tension pneumothorax compresses the mediastinum and vena cava thus restricting the flow of blood, which is the definition of stagnant hypoxia.
Pulsus paradoxus is a strong indicator of:
1) Pericarditis
2) Cardiac tamponade
3) Congestive heart failure
4) Tension pneumothorax
Cardiac tamponade
What is the first step in the underwater egress procedure?
Emergency Breathing Device - As required
Myoglobinuria may occur in a burn-injury patient due to which of the following?
1) Excessive fluid resuscitation
2) Administration of sodium bicarb
3) Breakdown of muscle tissue
4) Breakdown of visceral tissue
Breakdown of muscle tissue
You are transporting a 34-year-old male with increased intracranial pressure due to head trauma. He is presenting with an altered mental status and respiratory arrest. What type of herniation is this patient likely experiencing?
1) Upward
2) Central tentorial
3) Uncal
4) Cerebellar
Cerebellar
Cerebellar herniation presents with altered mental status and respiratory arrest.
Central tentorial herniation presents with diabetes insipidus due to tearing of the pituitary. Posturing and a blown pupil indicate uncal herniation, while upward herniation is seen in patients with bilateral pupil dilation and decerebrate posturing.
When an aircraft cabin pressure occurs above 33,000 feet, an individual's effective performance time is reduced by half due to
1) a higher PaO2 in the pulmonary capillaries
2) forced inhalation
3) hypocapnia
4) a decrease in cerebral perfusion pressure
a higher PaO2 in the pulmonary capillaries
On decompression at altitudes above 33,000 feet, an immediate reversal of oxygen flow in the alveoli takes place caused by higher PaO2 within the pulmonary capillaries. This depletes oxygen reserves in the blood. Forced exhalation can also decrease this time.
A 63-year-old male has right atrial enlargement. You should suspect
1) inverted P wave with poor progression
2) flattened P wave in leads V1, V2, and V3 with an amplitude of 1.5 mm
3) peaked P wave in leads II and III with amplitude of 2.5 mm
4) normal P wave progression in all unipolar leads
peaked P wave in leads II and III with amplitude of 2.5 mm
P pulmonale is characterized by tall, peaked P waves in leads II and III that have an amplitude of 2.5 mm or higher.
A 17-year-old male was found unresponsive by local EMS. His signs are HR 132, RR 28, BP 165/102, Temperature 39.3 Celsius with profuse sweating, and reported seizure activity. Bystander history suggests an accidental drug overdose. You should suspect he ingested
1) cocaine
2) synthetic cannaboid
3) ethanol
4) ecstasy
ecstasy
Ecstasy stimulates both peripheral and central sympathetic nervous system. Can produce mild to moderate CNS stimulation by euphoria, decreased fatigue, etc. progressing to anxiety, paranoia, hostility, hyperthermia, seizures.
When preparing a patient with a flail chest injury for transport, which position should be considered to facilitate better respiratory function?
1) Elevate the head of the stretcher to 30 degrees
2) Place the patient on the affected side
3) Place the patient on the unaffected side
4) Lower the head of the stretcher to -30 degrees
Place the patient on the affected side
Placing them on the injured side will help prevent the paradoxical motion of the flail chest, stabilizing the chest wall and minimize damage to the surrounding tissue.