The CFRN's medical domain packs an ICU syllabus into 35 items. The transport twist is time: what must be done before departure, and what can wait for the receiving unit.
Pulmonary: restrictive and obstructive disease, pulmonary embolism, inhaled pulmonary vasodilators.
Abdominal: abdominal compartment syndrome, GI bleeding, hollow and solid organ conditions.
Metabolic and endocrine: diabetic and neuroendocrine emergencies, sepsis.
Hematology and renal: coagulopathies and anemias; acute kidney injury and chronic renal failure.
Environmental and toxicological: allergic reactions, temperature, submersion, bites and envenomation, poisoning.
Stroke and heart disease are taught elsewhere here
Strokes, coronary syndromes, heart failure and dysrhythmias are on the CFRN outline. This site teaches stroke on SCRN hyperacute care and coronary and rhythm disease on CMC cardiovascular conditions, so this page and its questions leave them out unless transport changes the answer. Sepsis, kidney injury and GI bleeding sit here for now; this site has no CCRN pages yet.
The CTRN's conditions domain adds pulmonary hypertension, thyroid and adrenal disorders, and hematology and electrolyte abnormalities.
15 medical cases in transit
0 of 15 attempted · 0 correct · 0 missed
Scene operations, communications, safety and preparation
A rural emergency physician asks the flight nurse when a helicopter is MOST justified over a ground critical care unit for an interfacility transfer. The BEST answer is when
Answer and why, all 4 options
Air transport is justified when it shortens time to a time-sensitive intervention enough to change the outcome; distance alone does not justify the added cost and risk.
Insurance coverage is not a clinical indication and should not drive the choice of transport mode.
Preference does not override medical necessity and the extra risk of a helicopter flight.
A fixed mileage cutoff ignores road time, weather, the patient's condition and whether time actually matters.
Item 564226
Medical Emergencies · 35 items
The transport nurse is moving a patient with myasthenia gravis who received IV gentamicin for pyelonephritis at the referring facility. The patient now has weak cough, nasal speech and a forced vital capacity of 14 mL/kg. The patient's last pyridostigmine dose was 5 hours ago. The MOST likely cause of the deterioration is
Answer and why, all 4 options
Aminoglycosides block neuromuscular transmission and are a classic trigger of myasthenic crisis, here with bulbar weakness and a vital capacity near the intubation threshold.
Guillain-Barré is a new ascending neuropathy over days; this patient has known myasthenia and a clear drug trigger.
Cholinergic crisis needs excess anticholinesterase, and the last dose was 5 hours ago, with no muscarinic signs described.
Anaphylaxis would bring hypotension, urticaria or wheezing, not isolated bulbar and respiratory muscle weakness.
Item 565557
Medical Emergencies · 35 items
The transport nurse has given propranolol and propylthiouracil to a patient in thyroid storm. Temperature remains 40.8 °C (105.4 °F). Which intervention for the hyperthermia is MOST appropriate?
Answer and why, all 4 options
Dantrolene treats malignant hyperthermia, a muscle disorder, not the hypermetabolism of thyroid storm.
Waiting for labs leaves dangerous hyperthermia untreated; thyroid storm is a clinical diagnosis treated at once.
Aspirin displaces thyroid hormone from binding proteins and raises free hormone levels, which worsens the storm.
Acetaminophen with external cooling lowers the temperature without raising free thyroid hormone levels.
Item 566058
Medical Emergencies · 35 items
The transport nurse is moving an intubated patient with variceal hemorrhage who is receiving octreotide and ceftriaxone. After 2 units of PRBCs: Hgb 7.8 g/dL, BP 104/62 mmHg, HR 98 beats/min, no active hematemesis. Which action regarding transfusion is MOST appropriate?
Answer and why, all 4 options
Large crystalloid volumes raise portal pressure and dilute clotting factors, increasing the risk of rebleeding.
A restrictive threshold of about 7 g/dL with a target of 7–8 g/dL lowers rebleeding and mortality in variceal bleeding compared with liberal transfusion.
Platelets are given for a low count with active bleeding, not routinely to prevent rebleeding.
Transfusing to above 10 g/dL raises portal pressure and is linked to more rebleeding and death.
Item 566314
Medical Emergencies · 35 items
The transport nurse is moving a patient with DKA 1 hour into treatment on an insulin infusion. Urine output is 60 mL/h. The latest K+ is 4.3 mEq/L. Which potassium order is MOST appropriate?
Answer and why, all 4 options
Insulin is held only when K+ is below 3.5 mEq/L (2024 consensus); at 4.3 mEq/L it continues with replacement.
Waiting until K+ falls below 3.5 mEq/L risks hypokalemia, because insulin will keep moving potassium into cells.
IV push potassium can cause fatal arrhythmias; potassium is never given by push.
With K+ between 3.5 and 5.0 mEq/L and good urine output, adding 20–30 mEq to each liter keeps potassium in range as insulin drives it into cells.
Item 566473
Medical Emergencies · 35 items
The transport nurse is preparing an adult with suspected pneumococcal meningitis for transport. Ceftriaxone and vancomycin are about to be given. Which medication should be given just before or with the first antibiotic dose?
Answer and why, all 4 options
High-dose methylprednisolone is a spinal cord injury regimen that was abandoned; it is not the steroid used in meningitis.
Levetiracetam treats seizures; routine seizure prophylaxis is not part of the first-dose bundle.
Dexamethasone given just before or with the first antibiotic dose reduces neurologic sequelae and death in pneumococcal meningitis.
Mannitol is for signs of herniation, not routine use in meningitis.
Item 566486
Medical Emergencies · 35 items
A patient with severe hyperosmolar hyperglycemic state (glucose 1,100 mg/dL, effective osmolality 360 mOsm/kg) requires air medical transport. Which fluid strategy is SAFEST for preventing neurologic complications?
Answer and why, all 4 options
Sterile water IV causes hemolysis and an abrupt fall in osmolality.
Isotonic fluid restores volume first, and a gradual fall in osmolality limits water shift into brain cells and cerebral edema.
Rapid hypotonic boluses drop osmolality fast and drive water into brain cells, causing cerebral edema.
Hypertonic saline raises osmolality further; HHS needs a slow fall, not more solute.
Item 1882718
Special Populations · 15 items
Before moving a 230-kg patient from a third-floor room at a referring hospital to the aircraft, which pre-mission action is MOST important?
Answer and why, all 4 options
Every stretcher, lift, elevator, door and aircraft has a weight and size limit; checking each before the mission prevents equipment failure and injury.
Improvised sheets are not rated for the load and put the patient and crew at risk of injury.
A two-person lift is unsafe for a 230-kg patient; bariatric moves need extra staff and rated equipment.
Using an unrated cot even briefly risks collapse and adds an extra transfer.
Item 1882780
Special Populations · 15 items
An urgent transfer is requested for a patient whose body width extends well beyond the aircraft stretcher frame, preventing standard restraint. Which action should the flight nurse take?
Answer and why, all 4 options
Padding does not secure the patient; unrestrained limbs and body can shift and endanger the crew.
Sedation does not replace restraint and adds airway risk in a patient already hard to manage.
Improvised straps are not crash-tested for the load and do not make the patient fit the stretcher.
A patient who cannot be restrained on the stretcher becomes a hazard in turbulence or a crash, so the mission waits for a bariatric-capable unit.
Item 1882782
Medical Emergencies · 35 items
An intubated patient with status asthmaticus is on volume control ventilation. VT 450 mL (6 mL/kg PBW) RR 24 breaths/min I:E ratio 1:2 Pplat 29 cmH2O Auto-PEEP 12 cmH2O ABG: pH 7.24, PaCO2 62 mmHg BP is 92/58 mmHg. Which adjustment is MOST appropriate?
Answer and why, all 4 options
A 1:1 ratio shortens expiration and worsens air trapping in obstructive disease.
A larger tidal volume adds to dynamic hyperinflation when the plateau is already 29 cmH2O.
Lowering the rate lengthens expiratory time, lets trapped air empty, reduces auto-PEEP and improves BP; permissive hypercapnia is accepted.
A faster rate shortens exhalation, adds auto-PEEP and can cause hypotension or barotrauma.
Item 1882820
Scene operations, communications, safety and preparation
A flight crew is preparing survival clothing for winter missions over remote mountains. Which fabric should be AVOIDED as the base layer next to the skin?
Answer and why, all 4 options
Cotton holds moisture against the skin and loses its insulation when wet, which speeds heat loss in cold-weather survival.
Wool keeps much of its insulation when wet and is a good base layer.
Polypropylene wicks moisture away from the skin and is a standard base layer.
Polyester fleece insulates when damp and dries quickly, so it is suitable cold-weather clothing.
Item 1882938
Medical Emergencies · 35 items
A 62-year-old with acute type A aortic dissection needs emergent transport. The nearest hospital with an operating room is 15 minutes away, but cardiothoracic surgery there is 90 minutes out. An aortic center with an immediately available surgical team is 45 minutes away by air. Which destination decision is MOST appropriate?
Answer and why, all 4 options
An operating room is useless without the cardiothoracic team, which is 90 minutes away there.
Type A dissection is cured only by emergency surgery, so going straight to the team that can operate now gives the shortest time to definitive care.
Draining tamponade from a dissection without surgical repair can cause fatal rebleeding; it is not a planned stop on the way to the aortic team.
An intermediate stop adds a second handoff and transport while the dissection can rupture at any time.
Item 1941979
Medical Emergencies · 35 items
A patient with bleeding esophageal varices is intubated and has a Minnesota tube with both balloons inflated under traction for a helicopter transfer. Which item must be within immediate reach during the flight?
Answer and why, all 4 options
Iced lavage is no longer used for variceal bleeding and does nothing for a migrating balloon.
If the gastric balloon deflates or the tube migrates, the esophageal balloon can move up and obstruct the airway; cutting across the tube deflates both balloons at once.
Hanging weights are unsafe in an aircraft, and more traction raises the risk of mucosal injury and migration.
A replacement tube cannot be placed in a moving aircraft; the immediate danger is migration, which only rapid deflation solves.
Item 9730006
Medical Emergencies · 35 items
At a winter scene, a glucose meter carried in the aircraft's outside compartment reads 38 mg/dL for an alert, talking patient with warm, dry skin and no symptoms. Which action is MOST appropriate?
Answer and why, all 4 options
If the low value were real, an hour is too long to wait; if it is false, the cause is the cold meter, which should be fixed now.
Treating a probably false value in an alert, symptom-free patient risks hyperglycemia and hides the equipment problem.
Glucose meters and strips work only within a set temperature range; a cold-soaked meter can give a false value, so it is warmed to its operating range and the test is repeated before treating.
Urine glucose lags behind blood glucose and cannot detect hypoglycemia.
Item 9730020
Medical Emergencies · 35 items
A patient with a core temperature of 27 °C (80.6 °F) and a slow, weak pulse must be moved from a snowbank onto the aircraft stretcher. Which handling is MOST appropriate?
Answer and why, all 4 options
Rubbing the limbs adds rough stimulation and returns cold blood to the core.
Raising a severely hypothermic patient upright can drop BP and brain perfusion in a heart that cannot compensate.
A cold, irritable myocardium can go into ventricular fibrillation with rough movement, so the patient is lifted level and handled gently.
Exertion stresses a cold, irritable heart and can trigger collapse.
Item 9730032
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
Recurring wrong turns in medical cases
Aortic dissection, vasodilator first. The ACC/AHA aortic disease guideline (2022) starts with IV beta-blockade to bring down heart rate and then pressure; a vasodilator given before the rate is controlled drives reflex tachycardia and more shear on the aortic wall.
Running out of inhaled nitric oxide. Abrupt interruption can cause rebound pulmonary hypertension (FDA prescribing information for inhaled nitric oxide), so the delivery system and enough gas for the trip plus a margin travel with the patient.
Iodine before the thionamide in thyroid storm. The 2016 American Thyroid Association guideline gives iodine at least an hour after the thionamide, so the gland cannot use it to make more hormone.
Bicarbonate by reflex in DKA. The 2024 consensus report on hyperglycemic crises reserves bicarbonate for a pH below 7.0; above that, fluids and insulin correct the acidosis.
Trusting a normal SpO2 after smoke or exhaust exposure. Standard pulse oximetry reads carboxyhemoglobin as oxygenated hemoglobin; carbon monoxide needs CO-oximetry and high-flow oxygen whatever the saturation reads.
Fluids by habit in sepsis. The Surviving Sepsis Campaign (2021) suggests at least 30 mL/kg of crystalloid in the first 3 hours for sepsis-induced hypoperfusion, preferring balanced solutions to saline, and frequent reassessment.
Yes, among the neurologic emergencies. They are taught a single time here, on the SCRN pages, along with thrombolysis and thrombectomy.
How does the CTRN treat medical topics?
It combines them with injuries in one Patient Conditions domain of 65 scored questions and names a few topics the CFRN does not, such as thyroid and adrenal disorders.