Free FP-C Exam Flashcards

Do not continue VFR. Control the aircraft attitude, initiate a climb away from terrain, communicate the situation to ATC/dispatch, confess the IIMC entry, and comply with instrument procedures. Continued VFR flight into IMC is a leading cause of fatal HEMS crashes from spatial disorientation and controlled flight into terrain.

No non-essential conversation or activity is allowed during critical phases of flight, typically taxi, takeoff, landing, and operations below 10,000 ft. It reduces distraction-related errors during the highest-risk phases of a mission.

Any single crew member, whether pilot, medic, or nurse, can call an abort under the 'three to go, one to say no' principle. CRM empowers every team member to stop a mission without fear of reprisal.

CAMTS (Commission on Accreditation of Medical Transport Systems) sets voluntary safety and quality standards covering aircraft maintenance, crew training, clinical protocols, and risk management for medical transport programs.

Per Dalton's Law, total atmospheric pressure falls with altitude, so the partial pressure of oxygen drops even though the fraction of oxygen in air stays 21%. Lower inspired PO2 reduces the alveolar-to-blood oxygen gradient, causing hypoxic hypoxia.

Boyle's Law: pressure and volume are inversely related at constant temperature. As cabin altitude increases and ambient pressure falls, trapped gas expands. An untreated or small pneumothorax can enlarge in flight, so consider decompression before ascent when indicated.

TUC is the time from onset of hypoxia, such as sudden depressurization, until a person can no longer function or protect themselves. TUC shortens dramatically as altitude increases, from roughly 20-30 minutes at 18,000 ft to under a minute above 35,000 ft.

Etomidate (0.3 mg/kg IV) and ketamine (1-2 mg/kg IV) are preferred because both are hemodynamically neutral-to-supportive. Etomidate has minimal effect on blood pressure, and ketamine preserves sympathetic tone and airway reflexes, unlike propofol which causes hypotension.

Succinylcholine (1-1.5 mg/kg IV): onset 45-60 seconds, duration 5-10 minutes, depolarizing. Rocuronium (1-1.2 mg/kg IV RSI dose): similarly fast onset around 60 seconds but lasts 45-70 minutes, non-depolarizing, a much longer commitment if the airway proves difficult.

Insert a supraglottic airway or continue bag-mask ventilation and reattempt intubation with an optimized approach such as a bougie, video laryngoscopy, or repositioning. Surgical airway is reserved for 'can't intubate, can't oxygenate.'

Displacement (tube dislodged or mainstemmed), Obstruction (mucus, kinking, biting), Pneumothorax (often tension), Equipment failure (vent, oxygen source, circuit). Work through DOPE systematically before assuming a clinical decline.

A sustained square waveform with each breath confirms tracheal placement, versus the esophagus, which shows no waveform or one that rapidly decays. Unlike colorimetric detectors, waveform capnography monitors placement continuously throughout transport and reflects ventilation adequacy.

6 mL/kg of predicted (ideal) body weight, keeping plateau pressure under 30 cmH2O. This ARDSnet lung-protective strategy reduces ventilator-induced lung injury, and PEEP is titrated, commonly starting around 5 cmH2O, to maintain oxygenation.

Propofol causes dose-dependent vasodilation and myocardial depression, worsening hypotension. It works well for sedation in hemodynamically stable patients but is often avoided or dose-reduced in shock states in favor of ketamine or fentanyl-based sedation.

Can't intubate AND can't oxygenate, whether by bag-mask or supraglottic airway. This combination mandates an immediate surgical airway rather than further intubation attempts.

DKA: ketosis with an anion-gap metabolic acidosis, more common in Type 1 diabetes, glucose often above 250 mg/dL but can be lower. HHS: minimal or no ketosis, extreme hyperglycemia often above 600 mg/dL with hyperosmolarity and profound dehydration, more common in Type 2 diabetes and older adults.

Anion gap = Na+ minus (Cl- plus HCO3-); normal is roughly 8-12 mEq/L. An elevated gap suggests an unmeasured acid is present, such as in DKA, lactic acidosis, toxic alcohol ingestion, or uremia.

Septic shock is sepsis plus a vasopressor requirement to maintain MAP at or above 65 mmHg AND a serum lactate above 2 mmol/L despite adequate fluid resuscitation. Sepsis alone is infection with organ dysfunction, reflected by a SOFA score increase of 2 or more.

Norepinephrine, typically started around 0.01-0.05 mcg/kg/min and titrated to a MAP goal of at least 65 mmHg. It's preferred over dopamine due to a better safety and arrhythmia profile in most patients.

Stress-dose IV hydrocortisone or an equivalent steroid. Adrenal crisis is a relative or absolute cortisol deficiency, and fluids alone won't correct the underlying hormonal deficit driving refractory hypotension.

In respiratory arrest, give a full reversal dose, such as 2 mg IV/IN. In a spontaneously breathing but obtunded patient, titrate small doses, such as 0.04-0.4 mg, to restore adequate respirations while avoiding acute withdrawal and combativeness.

An elevated A-a gradient (alveolar minus arterial PO2, normal roughly 5-15 mmHg) points to V/Q mismatch, shunt, or a diffusion defect. A normal A-a gradient with hypoxemia instead points to hypoventilation or low inspired oxygen, such as at altitude, as the cause.

Treat ICP sustained above 22 mmHg, per BTF 4th edition guidance, updated from the older 20 mmHg threshold. Cerebral Perfusion Pressure (CPP) = MAP minus ICP; the general target is roughly 60-70 mmHg to maintain adequate cerebral blood flow.

Hypertension with a widened pulse pressure, bradycardia, and irregular respirations, appearing in that order as ICP rises toward herniation. It's a late, ominous sign requiring immediate aggressive ICP management.

Mannitol, an osmotic diuretic that draws fluid out of brain tissue into circulation, and hypertonic saline, which raises serum osmolality and pulls water out of brain cells. Both reduce cerebral edema and buy time en route to neurosurgical intervention.

LVO strokes are candidates for mechanical thrombectomy, only available at comprehensive stroke centers. Bypassing a closer primary stroke center for a thrombectomy-capable center can be appropriate if it doesn't unacceptably delay tPA-eligible care, per regional stroke triage protocols.

Watch for a drop in GCS of 2 or more points, a new or worsening unilateral fixed and dilated pupil, or posturing such as decorticate or decerebrate positioning. These precede the late Cushing's Triad and should trigger immediate hyperosmolar therapy and airway reassessment.

The intra-aortic balloon pump inflates during diastole and deflates just before systole, augmenting coronary perfusion and reducing afterload, but it only augments the heart's own output and needs a reasonably organized rhythm to time to. Impella actively pumps blood via a continuous-flow axial pump and works independent of rhythm.

Biphasic or deeply inverted T waves in leads V2-V3, indicating a critical proximal LAD stenosis. Patients are frequently pain-free at the time of the ECG, but Wellens syndrome predicts an impending large anterior MI if untreated, and stress testing is contraindicated.

IV magnesium sulfate, roughly 1-2 g, regardless of serum magnesium level, plus correction of the underlying QT-prolonging cause such as electrolytes or offending drugs. Overdrive pacing is used for refractory or recurrent cases.

Pump (cardiac contractility, effusion or tamponade, wall motion), Tank (volume status via IVC size and collapsibility, lung B-lines, free fluid), and Pipes (aorta for aneurysm or dissection, veins for DVT). It's a rapid bedside ultrasound protocol to classify shock type.

Cardiogenic shock presents with cold, clammy skin, low cardiac output, and often elevated filling pressures or pulmonary edema. Septic shock presents with warm, vasodilated skin early on, an infection source, and low SVR with normal-to-high cardiac output. Treatment differs: inotropes or mechanical support versus fluids plus norepinephrine.

300 mg IV/IO push for the first dose, followed by 150 mg for a second dose if VF or pulseless VT persists after subsequent defibrillation attempts, given per ACLS between defibrillation and epinephrine cycles.

General shock resuscitation targets a MAP of at least 65 mmHg. With a concurrent TBI, the goal often shifts higher and is individualized to maintain a CPP of 60-70 mmHg, since cerebral perfusion pressure, not just systemic MAP, determines brain perfusion adequacy.

Coagulopathy, acidosis, and hypothermia, each worsening the others in a vicious cycle that impairs clot formation and increases mortality. Prevention through active warming, minimizing crystalloid, and early blood products is a core damage-control resuscitation principle.

Targeting a lower-than-normal SBP of roughly 80-90 mmHg in penetrating or uncontrolled hemorrhage until the bleeding source is controlled, to avoid dislodging early clots with aggressive fluid resuscitation. It is avoided in traumatic brain injury, where adequate cerebral perfusion pressure requires a higher MAP.

4 mL times 70 kg times 30 equals 8,400 mL of lactated Ringer's over 24 hours, with half given in the first 8 hours from the time of injury, not time of arrival, and the remaining half over the next 16 hours.

1:1:1, packed red blood cells to fresh frozen plasma to platelets. This ratio approximates whole blood composition and helps correct trauma-induced coagulopathy alongside oxygen-carrying capacity, rather than giving PRBCs alone.

Pain out of proportion to the injury and pain with passive stretch of the affected muscles are the earliest, most sensitive findings. Pallor, paresthesia, pulselessness, and paralysis are late signs, and waiting for them risks irreversible muscle and nerve damage.

Tension pneumothorax. Treat immediately with needle decompression at the 2nd intercostal space midclavicular line, or the 4th/5th intercostal space anterior axillary line, or finger thoracostomy. Do not wait for chest X-ray confirmation.

Preeclampsia is hypertension plus proteinuria or other end-organ dysfunction after 20 weeks gestation, without seizures. Eclampsia adds new-onset grand mal seizures. Magnesium sulfate, with a 4-6 g IV loading dose, is first-line for both seizure prophylaxis and treatment.

Manually elevate the presenting fetal part off the cord and do not remove your hand until delivery. Position the mother knee-chest or in steep Trendelenburg or left lateral position, give high-flow oxygen, and transport emergently for cesarean delivery. Never attempt to replace the cord.

If heart rate remains below 60 bpm after 30 seconds of effective positive-pressure ventilation, begin chest compressions at a 3:1 compression-to-ventilation ratio. Epinephrine is added if the heart rate stays under 60 despite adequate compressions and ventilation.

It uses the child's length, measured head-to-heel, as a proxy for weight, then color-codes zones that correspond to pre-calculated drug doses, equipment sizes, and defibrillation energy settings, critical when a scale isn't available in the field.

The TEN-4 rule: bruising on the Torso, Ears, or Neck in a child under 4 years old, or any bruising in an infant under 4 months who isn't yet mobile, is highly suspicious for abuse and warrants further investigation.

Children with DKA face an elevated risk for cerebral edema, especially with rapid fluid shifts or overly aggressive correction. Use isotonic fluids and correct glucose and osmolality gradually over roughly 48 hours rather than the faster correction sometimes used in adults.

Croup presents with a barky, seal-like cough and inspiratory stridor, caused by parainfluenza, and is treated with racemic epinephrine nebulizer and dexamethasone. Bronchiolitis/RSV presents with wheezing and crackles in infants under 2, managed primarily with supportive care such as suction, oxygen, and hydration.

JUST Culture separates simple human error, which is consoled and used to fix the system, at-risk behavior, which is coached, and reckless behavior, which draws disciplinary action. It balances individual accountability with a blame-free environment that encourages honest error reporting.

GAMUT is a national quality-benchmarking database for critical care ground and air medical transport programs. Programs submit clinical and safety metrics to compare performance against peer programs and drive quality improvement.

Critical Incident Stress Management is a structured peer-support and debriefing process offered after high-stress or traumatic calls, such as pediatric deaths or difficult resuscitations, to support crew mental health and reduce burnout and PTSD risk.