FP-C study guide, domain by domain

When a scene request comes in, the communication specialist gives the pilot only the location and flight-relevant details, not the patient's age or condition, until the flight is accepted. What is the main reason for this practice?

1. To protect the patient's privacy under HIPAA

   The pilot belongs to the treating operation, so sharing clinical details with the crew is not a privacy breach; HIPAA is not why the details are held back.
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2. Pilots cannot interpret medical data

   Pilots are not asked to judge the patient at all; the issue is keeping clinical urgency out of an aviation safety decision, not the pilot's medical knowledge.
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3. To shorten the time to launch

   Leaving out a few words about the patient saves no meaningful time; the practice exists for safety, not speed.
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4. To keep emotion out of the go/no-go call

   Keeping emotion out of the go/no-go call lets the pilot decide on weather, aircraft and crew factors alone; knowing that a sick child or a crashed car is waiting is a recognized pressure to accept marginal conditions.
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Select an answer to record it. The card then marks the key and opens the reasoning under every choice.

A HEMS base learns that a tall construction crane will be installed 400 ft from its helipad for six months. The safety committee identifies the hazard, rates how likely and how severe a strike would be, and adds a lighting and approach-path change. Which component of a safety management system (SMS) is this?

1. Safety risk management

   Spotting a new hazard, rating its risk and adding controls such as lighting and a changed approach path is the safety risk management component of an SMS.
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2. Safety assurance

   Safety assurance monitors whether existing controls work through audits, data and performance measures; it checks controls once they exist rather than creating them.
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3. Safety policy

   Safety policy is the management commitment, accountability structure and written objectives, not the hazard-by-hazard analysis described here.
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4. Safety promotion and training

   Safety promotion is the training and communication that build safety culture; it would tell crews about the crane, but it is not where the risk is rated and mitigated.
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A patient with a diffusion impairment (interstitial fibrosis) becomes hypoxemic at altitude while PaCO2 stays normal. Why is CO2 elimination preserved?

1. CO2 crosses about 20 times faster than O2

   Carbon dioxide is far more soluble than oxygen, so it moves across a thickened alveolar-capillary membrane roughly 20 times more readily; a diffusion barrier lowers PaO2 long before it raises PaCO2.
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2. Altitude raises the alveolar PCO2 gradient

   Altitude lowers inspired oxygen pressure; it does not raise alveolar CO2, and hypoxic hyperventilation tends to push PaCO2 down.
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3. Hemoglobin binds CO2 more tightly than O2

   This confuses carbon dioxide with carbon monoxide; carbamino binding to hemoglobin is a minor share of CO2 transport and does not govern movement across the membrane.
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4. CO2 has a lower molecular weight than O2

   The reverse is true: CO2 (44) is heavier than O2 (32); its advantage is solubility, which outweighs the higher molecular weight.
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A patient was intubated with etomidate and succinylcholine 1.5 mg/kg. Eight minutes later, before takeoff, he begins spontaneous respiratory efforts and moves his arms. SpO2 99%, HR 102, BP 136/80. What is the most likely explanation?

1. Malignant hyperthermia

   Malignant hyperthermia shows rising EtCO2, muscle rigidity, tachycardia and fever; this patient has stable vital signs and purposeful movement instead.
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2. Expected offset of succinylcholine

   Succinylcholine wears off in roughly 5–10 minutes, so breathing and movement at 8 minutes is its normal duration; long-acting sedation and paralysis should be planned before then.
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3. Pseudocholinesterase deficiency

   A plasma cholinesterase deficiency prolongs the block for hours; it would delay, not hasten, the return of breathing.
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4. An inadequate succinylcholine dose

   1.5 mg/kg is a full intubating dose and the tube went in; recovery at 8 minutes reflects the drug's short action, not underdosing.
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Before RSI, a patient with multilobar pneumonia has been preoxygenated for 4 minutes with a non-rebreather at flush rate plus nasal cannula at 15 L/min. SpO2 plateaus at 90%. HR 116, BP 124/76, and he is cooperative. What is the most appropriate next step?

1. Add PEEP via BiPAP or a BVM with a PEEP valve

   A plateau at 90% despite high-flow oxygen points to shunt through flooded alveoli; PEEP, by BiPAP or a valved BVM, recruits them and is the step most likely to raise saturation before induction.
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2. Remove the nasal cannula so the mask seals better

   The cannula supplies apneic oxygenation during laryngoscopy and does not stop a mask from sealing; taking it off gives up oxygen rather than gaining it.
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3. Proceed with RSI; 90% is an acceptable start

   Starting at 90% leaves almost no oxygen reserve, so desaturation after induction would be fast and deep in this patient.
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4. Continue the non-rebreather for another 5 minutes

   Another 5 minutes on the non-rebreather will not fix shunt physiology; saturation has already plateaued.
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Five minutes after RSI and placement on the ventilator, a dehydrated patient's BP falls from 110/70 to 72/40. HR 122, SpO2 99%, EtCO2 32 mmHg with a normal waveform. Breath sounds are equal and PIP is 22 cmH2O. What is the most appropriate intervention?

1. Bilateral needle chest decompression

   Equal breath sounds, a normal capnography waveform and a modest peak pressure argue against tension pneumothorax, so needles add injury without benefit.
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2. An additional fentanyl bolus

   An additional fentanyl bolus lowers sympathetic tone further and would deepen the hypotension.
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3. Fluid bolus and a push-dose pressor

   A dehydrated patient loses sympathetic tone and venous return once induced and placed on positive pressure; volume plus a push-dose pressor restores preload and tone.
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4. Increase PEEP by 5 cmH2O

   Higher PEEP raises intrathoracic pressure and cuts venous return further, while oxygenation is already 99%.
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Twenty minutes into a unit of plasma, a patient develops localized hives on the chest and itching. Temperature 37.1 °C, BP 126/78, HR 88, SpO2 98%, no wheeze or swelling. What is the most appropriate management?

1. Continue the unit at the same rate

   Any new symptom during a transfusion calls for at least a pause and a bedside check before the unit goes on.
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2. Stop and treat as acute hemolysis

   Acute hemolysis brings fever, hypotension, back pain or dark urine; isolated hives with stable vitals are allergic, not hemolytic.
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3. Stop permanently and start epinephrine

   Epinephrine is for anaphylaxis with wheeze, swelling or hypotension, none of which is present.
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4. Pause, antihistamine, then resume

   Localized hives and itching with normal vital signs is a mild allergic reaction; pausing the unit, giving an antihistamine and restarting once the symptoms settle is accepted practice.
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A hyperkalemic patient with heart failure and an ejection fraction of 30% needs 25 g of dextrose with the insulin, in as little fluid as possible. Which order meets both goals?

1. D50W (25 mL)

   25 mL of 50% dextrose is only 12.5 g, half the dose: it saves volume by underdosing and leaves the patient open to hypoglycemia after the insulin.
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2. D50W (50 mL)

   50 mL of 50% dextrose holds 25 g (0.5 g/mL × 50 mL), the full dose in the least fluid that a heart with an ejection fraction of 30% has to handle.
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3. D25W (100 mL)

   100 mL of 25% dextrose carries 25 g, but in twice the volume of the 50% form.
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4. D10W (250 mL)

   250 mL of 10% dextrose also gives 25 g, at five times the volume, which a failing heart tolerates poorly.
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You are about to perform RSI on a patient with a severe TBI before a 45-minute flight to a neurosurgical center. Which assessment is MOST important to document immediately before induction?

1. Cranial nerve testing from II through XII

   A full cranial nerve exam takes too long before RSI and adds little; the pupils already carry the key cranial nerve information.
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2. Deep tendon reflexes in all four limbs

   Reflexes say little about intracranial pressure or herniation and do not guide TBI care.
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3. Motor GCS and pupil size and reactivity

   Induction and paralysis remove the motor exam for hours, so the best motor response and pupil size and reactivity are recorded first; they are the baseline for spotting herniation and for neurosurgical decisions.
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4. A complete NIH Stroke Scale

   The NIH Stroke Scale is built for ischemic stroke and cannot be completed on a patient obtunded enough to need RSI.
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A 30-year-old with a TBI (GCS 7) needs RSI. HR 122, BP 92/58, SpO2 94%. Your partner objects to ketamine because of intracranial pressure. Which induction agent is most appropriate?

1. Propofol 2 mg/kg IV

   A full 2 mg/kg propofol dose drops blood pressure, and even one hypotensive episode worsens outcome after TBI.
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2. Ketamine 1 mg/kg IV

   Ketamine keeps blood pressure up in a hypotensive patient, and current evidence does not show that it raises intracranial pressure when ventilation is controlled; avoiding hypotension protects cerebral perfusion.
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3. Fentanyl 5 mcg/kg IV

   A 5 mcg/kg fentanyl dose is a large opioid load that suppresses sympathetic tone and invites hypotension without reliably inducing on its own.
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4. Midazolam 0.3 mg/kg IV

   Midazolam at 0.3 mg/kg is slow in onset for RSI and lowers blood pressure in a patient who is already hypotensive.
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A patient with acute severe mitral regurgitation from a flail leaflet has pulmonary edema. BP 108/70, HR 108, SVR 1,900 dyn·s/cm⁵, CI 1.9 L/min/m². Surgery is planned at the receiving center. Which infusion best improves forward flow?

1. Esmolol

   Esmolol lowers contractility and heart rate, and the tachycardia is helping hold forward output in this low-index state.
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2. Nitroprusside

   In acute regurgitation, cutting afterload sends more of each beat forward into the aorta instead of back into the left atrium; with pressure adequate and SVR high, nitroprusside raises forward flow and eases pulmonary edema.
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3. Norepinephrine

   Raising afterload increases the fraction that regurgitates; norepinephrine is for a patient who has become hypotensive, which this one is not.
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4. Phenylephrine

   Phenylephrine, a pure alpha agonist, raises SVR without inotropy, which worsens regurgitant flow and pulmonary edema.
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A patient on an Impella CP has dark red urine. Plasma free hemoglobin and LDH are rising, the purge system is normal, and the device is at a high P-level. What is the most appropriate management?

1. Give fluids for suspected rhabdomyolysis

   Giving fluids for rhabdomyolysis misreads the picture: the pigmented urine comes with rising plasma free hemoglobin and LDH, which points to mechanical hemolysis rather than muscle breakdown.
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2. Treat it as an acute transfusion reaction

   Nothing links the urine to a transfusion; the laboratory picture fits pump-related hemolysis.
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3. Check its position and reduce pump speed

   Rising free hemoglobin and LDH with dark urine means the pump is shearing red cells, usually from malposition or high speed; confirming position, ideally by echo, and turning down the P-level (pump speed) is the first response.
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4. Stop the heparin in the purge solution

   The purge keeps the motor free of clot; stopping it invites pump thrombosis and does nothing for hemolysis.
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A patient with NSTEMI has 2 mm ST depression in V4–V6 and persistent 8/10 pain despite three sublingual nitroglycerin doses and a nitroglycerin infusion. BP 126/80, HR 92. Posterior leads are normal. What is the most appropriate disposition?

1. Routine angiography within 24–72 hours

   A 24–72 hour window fits lower-risk NSTE-ACS; ongoing pain on maximal medical therapy moves this patient into the immediate group.
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2. Transport for immediate angiography

   Refractory angina despite nitrates is a very-high-risk feature of NSTE-ACS, which calls for transport for immediate angiography, generally within 2 hours.
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3. Morphine and continued routine medical care

   Covering the pain with morphine leaves the ischemia untreated, and morphine has been linked to worse outcomes in NSTE-ACS.
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4. Fibrinolysis for the ongoing ischemia

   Fibrinolytics give no benefit and add bleeding risk without ST elevation; normal posterior leads rule out a hidden posterior STEMI.
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A 55-year-old with a suspected cervical spine injury after a fall has GCS 7 and needs a definitive airway before transport. HR 64, BP 102/60, SpO2 93%. Which approach is most appropriate?

1. Blind nasotracheal intubation

   Blind nasal intubation needs a breathing, cooperative patient and fails often; GCS 7 calls for a controlled definitive airway.
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2. RSI with the cervical collar left closed

   A closed collar limits mouth opening and worsens the laryngeal view; it is opened for the attempt while in-line stabilization takes over.
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3. Awake fiberoptic intubation in the aircraft

   Awake fiberoptic intubation needs a cooperative patient and a controlled setting, which a GCS of 7 and an aircraft cabin do not offer.
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4. RSI with manual in-line stabilization

   The front of the collar is opened and an assistant holds the head in line during laryngoscopy, which limits neck movement while allowing the mouth to open and the larynx to be seen.
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A lightning strike at a golf course injures three people. Victim A is pulseless and apneic. Victim B is confused, with fern-like marks on the chest. Victim C has an open tibia fracture and is screaming in pain. One flight crew is first on scene. Whom should the crew treat first?

1. Victim B, who is confused with skin marks

   Confusion and fern-like Lichtenberg marks are common and usually self-limited; this victim can wait while the arrested one is resuscitated.
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2. Victim C, who has the open fracture

   A screaming patient with an open fracture has a working airway and circulation, which makes him a lower priority in a lightning incident.
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3. Victim A only after B and C are stabilized

   Delaying CPR until the others are stabilized loses the window in which lightning-induced arrest is most often reversible.
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4. Victim A, who is pulseless and apneic

   Victim A, pulseless and apneic, comes first: after lightning, victims who are moving and breathing usually survive, while cardiopulmonary arrest is often reversible with prompt CPR and ventilation, so the apparently dead are treated first.
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Four hours after a house fire, a 35-year-old with 40% TBSA burns has a circumferential full-thickness burn of the right arm. Doppler signals at the radial artery are fading, and the fingers are cool and mottled. What is the most appropriate intervention to restore distal perfusion?

1. Escharotomy

   A circumferential full-thickness burn forms a rigid eschar that constricts the limb as edema builds; incising the eschar releases it and restores distal flow.
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2. Fasciotomy

   Fasciotomy opens the fascia for compartment syndrome beneath it; here the constricting layer is the burned skin, which escharotomy releases first.
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3. Elevate the arm and recheck in 1 hour

   Elevation helps edema, but fading Doppler signals and mottled fingers mean ischemia is under way, and an hour's wait risks the limb.
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4. Increase the LR infusion rate

   Raising the LR rate adds tissue edema and tightens the band further; it does not relieve a mechanical constriction.
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A 30-week neonate weighing 1.4 kg requires intubation for transport. Using NRP gestational-age and weight guidance, which endotracheal tube size is most appropriate?

1. 3.0 mm

   NRP sizing puts 28–34 weeks and 1–2 kg at a 3.0 mm tube, which fits a 30-week, 1.4-kg baby.
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2. 2.5 mm

   A 2.5 mm tube is for infants under 28 weeks or under 1 kg; here it is undersized, with more resistance and a higher risk of blockage.
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3. 3.5 mm

   3.5 mm suits babies beyond 34 weeks and above 2 kg and is too large for a 1.4-kg preterm airway.
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4. 4.0 mm

   4.0 mm belongs to large term newborns and older infants, far too big for this airway.
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A 28-week patient with preterm premature rupture of membranes is afebrile, not contracting, and has a reassuring fetal heart rate. The receiving obstetrician asks which therapy should begin before transfer. What is most appropriate?

1. Betamethasone and latency antibiotics

   With PPROM before 34 weeks and no infection, a corticosteroid course speeds fetal lung maturity and latency antibiotics prolong pregnancy and lower infection; both can start before transfer.
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2. Antibiotics only; steroids are contraindicated

   Steroids are recommended in PPROM before 34 weeks when there is no infection; leaving them out gives up the lung benefit.
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3. Terbutaline and betamethasone

   Terbutaline has nothing to treat because she is not contracting, and tocolysis is not recommended in PPROM.
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4. Oxytocin to induce labor before departure

   At 28 weeks with reassuring fetal status and no infection the plan is expectant management; inducing now delivers a very preterm infant without steroid benefit.
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A 15 kg child has lost an estimated 300 mL of blood from a scalp laceration. Using the estimated pediatric blood volume, approximately what fraction of circulating volume has been lost?

1. About 20%

   20% comes from assuming 100 mL/kg, a figure closer to a premature newborn than a school-age child.
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2. About 33%

   33% results from a 60 mL/kg estimate, which understates pediatric blood volume.
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3. About 25%

   At about 80 mL/kg, a 15 kg child has roughly 1,200 mL of blood, and 300 mL is one quarter of it.
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4. About 40%

   40% would need a blood volume of only 750 mL (50 mL/kg), well below any pediatric estimate.
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A 9-year-old in status epilepticus was intubated with rocuronium after two benzodiazepine doses and levetiracetam. Forty minutes later, HR has risen to 150, BP to 160/100, and pupils are dilated and sluggish. EtCO2 and SpO2 are normal. What is the most likely explanation?

1. Normal stress response to intubation

   A normal stress response to laryngoscopy fades within minutes; a new rise 40 minutes later needs another explanation.
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2. Inadequate paralysis from rocuronium

   Inadequate paralysis would show as movement, breathing against the ventilator or a change in EtCO2, none of which is described.
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3. Ongoing seizure masked by paralysis

   Paralysis hides convulsions but not the electrical seizure; a new rise in heart rate and blood pressure with dilated, sluggish pupils suggests nonconvulsive status, which needs more antiseizure therapy and EEG.
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4. Anaphylaxis to rocuronium

   Anaphylaxis brings hypotension, bronchospasm and rising airway pressures, not hypertension with normal EtCO2 and SpO2.
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You arrive in a trauma bay with an intubated patient. The trauma team is eager to begin. What is the best practice for the verbal handoff?

1. Report while the team moves the patient over

   Talking during the transfer splits attention, and key details are missed while hands are busy with the patient and lines.
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2. A brief structured report while the team pauses

   A short standardized handoff given while the receiving team stops to listen lets everyone hear the same information and cuts omissions.
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3. Report privately to the attending in the hallway

   Briefing only the attending leaves the nurses, respiratory therapist and others without the information they will act on.
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4. Skip the verbal report and hand over the chart

   Paperwork does not replace a verbal handoff; the chart may be incomplete and the team cannot ask questions.
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Two hours after a deep dive, a patient being flown to a hyperbaric center at a cabin altitude of 5,000 ft develops worsening joint pain, mottled skin and confusion. What is the most appropriate in-flight intervention?

1. Continue at altitude; oxygen alone is enough

   Oxygen helps wash out nitrogen, but at 5,000 ft the lower ambient pressure keeps the bubbles larger; with neurologic signs the cabin altitude has to come down as well.
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2. Climb to shorten the flight time

   Climbing lowers cabin pressure further and lets bubbles expand, worsening the decompression sickness the transport is meant to treat.
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3. Give aspirin and hold the current altitude

   Aspirin does nothing for bubble size, and holding altitude leaves the pressure problem untreated.
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4. Descend as low as safe, on high-flow oxygen

   Lower cabin altitude raises ambient pressure and shrinks nitrogen bubbles (Boyle), while high-flow oxygen widens the gradient that pulls nitrogen out of tissue until recompression; new confusion means the illness is progressing.
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A crew transports a 19-year-old with fever, a petechial rash and neck stiffness; meningococcal disease is later confirmed. Which crew member most needs post-exposure chemoprophylaxis?

1. The medic who gave only the verbal handover

   A brief verbal report is not close contact with secretions and does not warrant prophylaxis.
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2. The pilot in a separate cockpit

   A separate cockpit keeps the pilot out of droplet range of the patient.
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3. The medic who intubated without a mask

   Meningococcus spreads by respiratory droplets, so unprotected contact with airway secretions, as during intubation without a mask, is the exposure that calls for chemoprophylaxis such as ciprofloxacin, rifampin or ceftriaxone.
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4. The nurse who wore a surgical mask

   A properly worn surgical mask blocks droplets, which is the barrier this organism requires.
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You are preparing to fly an 84-year-old man from a rural hospital to a thrombectomy-capable center. He has dense left-sided weakness and a gaze deviation, and he lived independently until this morning. The receiving center has accepted him, but the referring physician suggests canceling the flight because he is too old for endovascular therapy. What is the most appropriate course?

1. Proceed with the flight to thrombectomy care

   Age alone does not exclude thrombectomy; with a large deficit and good baseline function an 84-year-old can still benefit, so proceeding with the flight to a thrombectomy-capable center is the right course.
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2. Cancel the flight on the basis of his age

   Current stroke guidelines set no upper age limit for endovascular therapy, and patients over 80 were included in the trials that showed benefit.
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3. Cancel and admit him for palliative care locally

   Palliative care is a goals-of-care decision made with the patient and family, not a default triggered by age while effective treatment is available.
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4. Divert to a primary stroke center without thrombectomy

   A primary stroke center without thrombectomy would need a second transfer, losing brain-saving time.
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The investigation of a HEMS accident finds that a relaxed fatigue policy, a request that had been declined by another operator for weather, and an inoperative radar altimeter all combined on the same night. Which safety concept best describes this?

1. Heinrich's accident pyramid

   Heinrich's pyramid relates the numbers of near misses and minor events to serious ones; it does not describe defenses failing together.
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2. Normalization of deviance

   Normalization of deviance is a gradual drift in which one unsafe shortcut becomes routine; it does not describe several independent defenses failing at once.
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3. The Just Culture algorithm

   The Just Culture algorithm sorts one person's behavior into human error, at-risk or reckless after an event; it is not a model of how accidents arise.
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4. Reason's Swiss cheese model

   Separate layers of defense each had a hole (a relaxed fatigue policy, a flight already declined by another operator for weather, a broken radar altimeter), and the holes lined up on one night, which is Reason's Swiss cheese picture of latent failures combining into an accident.
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