Certified Flight Paramedic (FP-C) Decision Guide Study Guide

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For a night transfer involving worsening weather, a tired crew and frequent airway interventions, assess the combined risk. Consider a rested crew, different timing or another transport arrangement before acceptance.

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During loading rehearsal, the clinician can reach the ventilator but must release a restraint to reach suction. Reposition and secure suction, then repeat the access check with the clinician restrained.

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A ground clinician sees poles beside an open field but cannot identify every connecting wire. Report the pole line, suspected wire corridor and uncertain extent using agreed directional references.

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After repeated overnight transfers, a clinician reports slowed concentration before an unpressurised flight. Treat the report as relevant safety information and address fitness for duty before adding further workload.

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A training system has 1,200 usable litres and verified consumption of 10 litres per minute, giving 120 minutes. A 100-minute complete transfer leaves 20 minutes to compare with the specified contingency requirement.

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A sealed flexible space contains 40 mL at 760 mm Hg absolute pressure. At 608 mm Hg, its predicted volume is 50 mL, assuming constant temperature and no gas loss.

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Compare severe anemia, low cardiac output and cyanide exposure. Their dominant mechanisms concern carrying capacity, circulation and cellular utilisation respectively, even when supplemental oxygen is available.

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Following a pressurisation problem, a crew member becomes unusually cheerful and struggles with a familiar connector. Begin the oxygen response and communicate immediately rather than waiting for collapse.

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A conscious passenger with congestion develops fullness early in descent. Encourage prompt equalisation efforts and report symptoms. Persistent pain warrants discussion with the flight crew about a safe adjustment to descent.

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After intubation during resuscitation, chest movement appears symmetrical but the trace is absent. Immediately reassess ventilation, tube position, circulation and the capnography connection rather than accepting condensation as confirmation.

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Following an unsuccessful adult attempt, a supraglottic airway restores chest movement, exhaled carbon dioxide and saturation. Stabilise before another strategy. If mask and supraglottic ventilation also fail, recognise the need for immediate invasive rescue.

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An intubated patient with obstruction becomes hypotensive after a rate increase. Expiratory flow never reaches zero. Assess gas trapping and adjust ventilation to permit more complete emptying while evaluating other causes of deterioration.

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At unchanged settings, peak rises from 28 to 42 cm H2O while plateau remains 20. Investigate tube kinking, secretions and bronchospasm before assuming reduced compliance.

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An alert adult with COPD has respiratory rate 32, pH 7.28 and PaCO2 68 mm Hg despite initial treatment. Preserved airway protection and stable circulation support a closely monitored bilevel NIV trial.

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A patient initially tolerates NIV but becomes difficult to awaken, develops pooled secretions and worsening acidosis. Support oxygenation and circulation while preparing escalation rather than repeatedly extending the same trial.

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A ventilated head-injured patient has low saturation with end-tidal carbon dioxide 37 mm Hg. Assess oxygen supply, airway and pulmonary causes while maintaining an appropriate ventilation strategy rather than automatically increasing respiratory rate.

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A hypotensive patient with severe bronchospasm deteriorates after intubation and rapid ventilation. Reassess circulation, tube and circuit function, expiratory emptying and possible excessive intrathoracic pressure together.

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A paralysed patient reaches the aircraft with an empty sedative syringe. Restore the prescribed sedation and analgesia while checking pressure, infusion delivery and ventilation. Do not use immobility as evidence of comfort.

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A patient with suspected pneumonia develops confusion, oliguria and hypotension despite a modest inflammatory marker result. Continue urgent evaluation and resuscitation rather than treating one reassuring test as exclusion.

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During septic shock transport, lactate remains elevated while pressure improves and pulmonary congestion develops. Reassess fluid responsiveness, cardiac function and treatment effects rather than repeatedly giving fluid solely to normalise lactate.

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After initial fluid, a 58-year-old remains confused at MAP 52 mm Hg and develops congestion without evidence of fluid responsiveness. Start norepinephrine toward the initial target while reassessing perfusion, rhythm and access.

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Missed dialysis and prearrest QRS widening support suspicion during collapse. Continue CPR and indicated rhythm treatment while considering cause-directed therapy and obtaining available biochemical information.

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A patient with COPD has pH 7.23, PaCO2 80 mm Hg and elevated bicarbonate. The current acidemia warrants assessment for acute deterioration rather than an assumption that all abnormalities are chronic.

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An unresponsive adult has a definite pulse but barely breathes after suspected opioid exposure. Open the airway, support ventilation and administer an antagonist, then repeatedly reassess breathing and circulation.

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After a tricyclic overdose, hypotension accompanies progressive QRS widening. Give indicated bicarbonate while supporting ventilation and circulation, then reassess both clinical improvement and biochemical effects before further treatment.

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After substantial gastrointestinal bleeding, a patient has SpO2 99% but severe anemia, confusion and hypotension. Assess oxygen-carrying capacity and circulation rather than accepting saturation as proof of adequate delivery.

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An adult with severe TBI has SBP 102 mm Hg despite normal saturation. Reassess bleeding, circulating volume and treatment effects because pressure remains below the suggested adult target.

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After a rate increase, end-tidal carbon dioxide and arterial PaCO2 both fall to 25 mm Hg without herniation signs. Reduce excessive minute ventilation toward normocapnia while preserving oxygenation and reassessing response.

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A patient's pre-intubation motor response was localising, but no movement occurs after rocuronium. Communicate the original component scores and drug timing while continuing pupil and physiological assessment.

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MAP 80 minus ICP 25 gives CPP 55 mm Hg. MAP 65 with the same ICP gives 40. Both prompt evaluation of circulation, ICP trend and measurement setup before targeted intervention.

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A previously independent patient develops isolated aphasia three hours ago. Describe the communication loss and expedite stroke-team assessment rather than labelling the event minor solely from the score.

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A patient has findings concerning for large-vessel occlusion. The nearer hospital lacks endovascular treatment and has slow transfers. Compare actual treatment access through the regional pathway rather than choosing by distance alone.

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A patient with chest pressure develops similar ST changes in II, III and aVF. Recognise an inferior-facing pattern and integrate the complete ECG and clinical presentation.

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An ECG shows prolonged PR intervals with narrow QRS complexes. Describe delayed conduction before ventricular activation rather than calling ventricular depolarisation prolonged.

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Compare abrupt regular tachycardia with new hypotension against gradually increasing sinus tachycardia during active bleeding. The former may need rhythm-directed intervention; the latter requires correction of the circulatory cause.

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Pacing spikes precede broad complexes, but the patient remains poorly perfused. Check a corresponding pulse and pressure response before declaring effective pacing or reducing attention to circulatory support.

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During transport, confirm inflation near the dicrotic notch and deflation before the next systolic upstroke. A newly cool or poorly perfused access-side foot requires urgent assessment even if central pressure remains satisfactory.

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A patient has chest pressure, inferior ST elevation, SBP 84 mm Hg and clear lungs. Withhold nitroglycerin immediately because the pressure is already below 90 mm Hg. Obtain right-sided leads, especially V4R, and reassess circulation while arranging urgent coronary reperfusion. Even if V4R does not demonstrate ST elevation, the existing hypotension remains sufficient reason to withhold nitrates.

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A cooperative adult with severe dyspnea, pulmonary edema and BP 190/110 mm Hg may benefit from monitored positive-pressure support while the cardiac cause is treated. New hypotension or lost airway protection changes suitability.

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An alert LVAD patient has warm skin and normal conversation but no radial pulse. Use suitable pressure assessment and device checks rather than initiating compressions solely because pulsatility is absent.

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A bleeding patient is cold, acidemic and coagulopathic. Communicate the combined deterioration, preserve warmth and expedite bleeding control instead of treating each abnormality as an unrelated problem for later correction.

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A patient is transferred after abdominal packing and temporary closure. Clarify residual injuries, expected bleeding, temporary measures and the return-to-theatre plan, then organise surveillance around recurrent hemorrhage and physiological instability.

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During ongoing bleeding, coordinate products through the transfusion plan, verify identity, use appropriate warming equipment and follow temperature, ionised calcium, potassium, coagulation and perfusion. Communicate product use and remaining supply during handover.

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An adult with TBI and abdominal hemorrhage rises from SBP 82 to 104 mm Hg after blood, then deteriorates again. Continue resuscitation and expedite source control rather than accepting pressure because it exceeds 90.

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A 70-kg adult has 30% TBSA partial-thickness and full-thickness thermal burns. Calculate 2 × 70 × 30 = 4,200 mL of initial estimated resuscitation fluid. If lactated Ringer's starts immediately after injury with no previous fluid, the conventional Modified Brooke schedule gives 2,100 mL over eight hours, initially 262.5 mL/hour, followed by 2,100 mL over sixteen hours, initially 131.25 mL/hour. If assessment instead begins two hours after injury and 600 mL has already been given, the remaining first-eight-hour allocation is 1,500 mL over six hours, or 250 mL/hour before titration. The initial urine-output goal is approximately 35 mL/hour. Reassess hourly and adjust the infusion using urine output, blood pressure, peripheral perfusion and overload findings.

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A worker falls after electrical contact and has a small hand burn. Once the source is isolated, assess rhythm, perfusion and traumatic injury before focusing on local wound care.

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An enclosed-space fire survivor has altered consciousness and circulatory collapse. Consider toxic exposure alongside airway injury; properly functioning oxygen equipment does not exclude impaired carriage or cellular use.

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A patient arrests at 14:00 with the fundus above the umbilicus. Begin CPR, assign manual displacement and start delivery preparation immediately so an indicated delivery can be completed by 14:05.

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A small newborn becomes cool during transfer and develops increasing respiratory effort. Measure temperature and glucose while evaluating breathing and circulation, restore controlled warmth and recheck after transitions.

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Soon after delivery, a patient develops profound hypoxemia, hypotension and diffuse puncture-site bleeding. Mobilise obstetric and critical care support and coordinate blood products while investigating other causes of collapse.

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A postpartum patient remains at 168/112 mm Hg after 15 minutes and reports visual disturbance. Start appropriate pressure treatment and magnesium prophylaxis while monitoring respiration, reflexes, renal function and neurological status.

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Before departure, test the primary and backup arrangements, verify battery duration and oxygen consumption, and demonstrate manual ventilation and suction with the child's interface.

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Glucose falls during treatment but significant ketonemia and acidosis persist. Adjust dextrose and insulin according to the pediatric plan rather than stopping insulin for glucose improvement alone.

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A febrile child becomes confused and poorly perfused while a nonblanching rash spreads. Prioritise stabilisation, urgent transfer and indicated antimicrobial treatment without delaying for nonessential diagnostic procedures.

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A quiet child has acceptable saturation, but the caregiver reports loss of usual eye contact and movement. Investigate ventilation, circulation, infection and equipment function rather than assuming the behaviour is baseline.

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A rescued child is unresponsive and not breathing normally. Once safely removed, promptly assess circulation and begin indicated ventilation and resuscitation rather than positioning the child to drain water.

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A clinician reports selecting the wrong vial from nearly identical packaging before administration. Examine storage, selection and working conditions before deciding whether the behaviour was an inadvertent slip or conscious risk-taking.

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Several teams omit the same equipment check during rushed handovers. Examine timing, ownership and task placement, redesign the process and evaluate completion rather than repeating identical training after each recurrence.

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Before adopting an adult respiratory-support study for all transported children, examine inclusion criteria, measured outcomes, recommendation certainty and the capacity to rescue treatment failure.

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If 45 of 50 eligible transfers document post-movement tube confirmation, completion is 90%. Keep eligibility and documentation rules stable before comparing periods or evaluating a revised handover process.