IBSC CCP-C Certified Critical Care Paramedic

A critical care transport crew is preparing to transfer a ventilated patient from an ICU to a receiving facility 45 minutes away. During the pre-transport checklist, the crew discovers the portable ventilator battery shows 60% charge. What is the MOST appropriate action?

• AProceed with transport since 60% battery is sufficient for 45 minutes
• BReplace or fully charge the battery before departing and verify backup power
• CSwitch the patient to a bag-valve mask for transport to conserve battery
• DRequest a shorter transport route to reduce battery drain

During a critical care interfacility transport, the flight nurse and paramedic disagree about the need to increase the vasopressor dose. Which crew resource management principle should guide their interaction?

• AThe paramedic should defer to the nurse's judgment since nurses have higher licensure
• BThe disagreement should be tabled until arrival at the receiving facility
• CBoth crew members should use assertive communication to share concerns and reach a collab…
• DThe pilot or driver should make the final medical decision to avoid conflict

A transport crew is conducting a risk assessment before accepting a nighttime ground transport of a critically ill patient through mountainous terrain. Which risk assessment tool is commonly used in transport medicine to evaluate mission hazards?

• AGlasgow Coma Scale
• BAPACHE II scoring system
• CRisk assessment matrix (RAM) or go/no-go checklist
• DSequential Organ Failure Assessment (SOFA) score

Which of the following stressors is MOST likely to affect both the patient and crew during prolonged ground critical care transport?

• AHypoxia from altitude changes
• BVibration causing motion artifacts on monitoring equipment
• CDecreased barometric pressure expanding trapped gases
• DSolar radiation exposure through aircraft windows

A critical care paramedic is preparing to perform rapid sequence intubation (RSI) on a hemodynamically unstable patient. Which induction agent is MOST appropriate for this patient?

• APropofol 2 mg/kg IV
• BMidazolam 0.3 mg/kg IV
• CKetamine 1.5 mg/kg IV
• DThiopental 3 mg/kg IV

During transport, a mechanically ventilated patient on volume-controlled ventilation suddenly develops high peak airway pressures with normal plateau pressures. What is the MOST likely cause?

• ATension pneumothorax
• BKinked or obstructed endotracheal tube
• CWorsening ARDS with decreased lung compliance
• DPulmonary embolism

Which neuromuscular blocking agent has the SHORTEST duration of action and is preferred for RSI when a short-acting paralytic is desired?

• ARocuronium 1.2 mg/kg
• BVecuronium 0.1 mg/kg
• CSuccinylcholine 1.5 mg/kg
• DCisatracurium 0.2 mg/kg

A critical care paramedic is managing a patient on pressure-controlled ventilation with settings of PC 20, PEEP 10, RR 16, FiO2 0.6. The patient's SpO2 is 88% and PaO2 is 55 mmHg. What is the MOST appropriate initial ventilator adjustment?

• AIncrease the respiratory rate to 24
• BIncrease PEEP to 14 cmH2O
• CIncrease FiO2 to 1.0
• DSwitch to volume-controlled ventilation

During RSI, which of the following is the CORRECT order of steps?

• AParalytic, induction agent, preoxygenation, intubation
• BPreoxygenation, induction agent, paralytic, intubation
• CInduction agent, preoxygenation, paralytic, intubation
• DPreoxygenation, paralytic, induction agent, intubation

A transport ventilator alarms for low tidal volume delivery. The patient is intubated with an 8.0 ETT and the cuff pressure is 22 cmH2O. Auscultation reveals diminished breath sounds bilaterally with a leak heard over the neck. What is the MOST likely problem?

• ARight mainstem intubation
• BETT cuff leak or herniation
• CCircuit disconnection at the ventilator
• DMucus plugging of the ETT

Which ventilator mode delivers a set pressure during inspiration and allows the patient to determine their own tidal volume and respiratory rate on spontaneous breaths?

• AAssist-Control Volume Ventilation (AC/VC)
• BPressure Support Ventilation (PSV)
• CSynchronized Intermittent Mandatory Ventilation (SIMV)
• DAirway Pressure Release Ventilation (APRV)

A patient receiving continuous sedation with propofol during transport develops new-onset metabolic acidosis, rhabdomyolysis, and bradycardia. Which condition should be IMMEDIATELY suspected?

• AMalignant hyperthermia
• BPropofol infusion syndrome (PRIS)
• CSerotonin syndrome
• DNeuroleptic malignant syndrome

Which of the following best describes the mechanism of action of rocuronium?

• ADepolarizes the motor end plate causing initial fasciculations followed by paralysis
• BCompetitively blocks acetylcholine at the nicotinic receptor without depolarization
• CInhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction
• DDirectly acts on skeletal muscle calcium channels to prevent contraction

A ventilated patient develops sudden oxygen desaturation, hypotension, absent breath sounds on the left, and tracheal deviation to the right during transport. After confirming ETT placement, what is the MOST appropriate immediate intervention?

• AIncrease FiO2 to 100% and PEEP to 20 cmH2O
• BNeedle decompression of the left chest at the second intercostal space, midclavicular line
• CAdminister a 1-liter normal saline bolus for hypotension
• DPerform emergent pericardiocentesis

When performing post-intubation sedation for a critical care transport patient, which combination provides BOTH sedation and analgesia?

• APropofol and midazolam
• BFentanyl and ketamine
• CMidazolam and lorazepam
• DPropofol and dexmedetomidine

A transport patient on APRV (Airway Pressure Release Ventilation) has settings of P-high 28, P-low 0, T-high 4.5 sec, T-low 0.5 sec. The patient's oxygenation has improved and the team wants to begin weaning. What is the appropriate first step in weaning APRV?

• ADecrease P-high and increase T-high (drop and stretch method)
• BIncrease P-low to 10 cmH2O
• CDecrease T-low to 0.2 seconds
• DSwitch immediately to SIMV mode

A patient with a known difficult airway requires intubation during transport. After two failed direct laryngoscopy attempts, what is the MOST appropriate next step according to the difficult airway algorithm?

• AAttempt a third direct laryngoscopy with a smaller blade
• BTransition to a supraglottic airway device and continue transport
• CPerform an immediate surgical cricothyrotomy
• DContinue bag-valve mask ventilation indefinitely

Which of the following is a contraindication to succinylcholine use during RSI?

• AAsthma with active bronchospasm
• BPatient with a burn injury sustained 3 days ago
• CMorbid obesity (BMI > 40)
• DSuspected cervical spine injury

During transport, the ETCO2 waveform on a ventilated patient suddenly drops to zero with continued chest rise. What is the MOST likely explanation?

• AThe patient has developed cardiac arrest
• BThe ETCO2 sensor is disconnected or malfunctioning
• CThe patient has a massive pulmonary embolism
• DThe endotracheal tube has migrated into the esophagus