Your FREE CFRN Flashcards 2026 – 200+ Cards

The Board of Certification for Emergency Nursing (BCEN).

175 items — 150 scored + 25 unscored pretest.

180 minutes (3 hours total seat time).

108 of 150 scored items correct (a raw cut score, ~72%).

Criterion-referenced — pass/fail against a fixed cut score, not a curve.

General Principles of Flight Transport Nursing (30), Resuscitation (40), Trauma (30), Medical Emergencies (35), Special Populations (15).

Resuscitation Principles — 40 scored items (~27%).

Current unrestricted RN license (US, US territory, Canada, Australia, or equivalent); 2 yrs experience recommended, not required.

4 years; renew by 100 CE contact hours ($\geq$75 clinical) or by exam.

Retest after a 90-day wait; discounted retest within 1 year; Test Assurance option available.

CFRN = flight (air medical) transport nurse; CTRN = certified transport registered nurse (ground/surface), both BCEN credentials.

The practice analysis BCEN uses to define what flight nurses do and build the exam content outline.

$P_1 V_1 = P_2 V_2$ — as pressure falls on ascent, trapped gas EXPANDS (pneumothorax, GI gas, ET cuff, air splints).

Total pressure = sum of partial pressures; at altitude total pressure falls, so the partial pressure of O₂ falls → hypoxia at the same FiO₂.

Dissolved gas is proportional to its partial pressure; as pressure falls, gas leaves solution → decompression sickness (nitrogen bubbles).

Boyle's law — it drives most barometric (dysbarism) injuries from trapped-gas expansion.

Injury from changing ambient pressure — barotrauma to ears, sinuses, GI tract, lungs, and decompression sickness.

Fill the ET cuff with saline (not air) or recheck cuff pressure at altitude, since cuff air expands on ascent.

Place a chest tube for any pneumothorax and vent the stomach with a gastric tube before flight.

Hypoxia, barometric, thermal, decreased humidity, noise, vibration, fatigue, gravitational (G) forces, spatial disorientation, flicker vertigo.

Roughly a 2 °C drop per 1,000 ft — a hypothermia risk that feeds the trauma lethal triad.

Dry cabin air thickens secretions and dries mucous membranes.

Impairs auscultation and communication — rely on capnography/invasive monitoring and use hearing protection.

Degrades NIBP/SpO₂ readings and fatigues the crew; secure equipment.

Rotor/light strobe through the eyes that can provoke nausea, disorientation, or (rarely) seizures.

Loss of visual reference in flight — a crew safety/survival hazard.

$\approx$100 $\times$ 100 ft, level, firm, free of obstructions/wires/debris, with hazards communicated to the pilot.

Approach from the FRONT in the pilot's line of sight; never from the rear (tail rotor) or uphill side; keep low.

The pilot has final authority to refuse/abort a flight for weather or safety — no clinical urgency overrides it.

Blankets/sheets/debris can be drawn into a rotor — secure everything before approach.

Simple Triage And Rapid Treatment — a mass-casualty system to do the most good for the most patients.

Federal law requiring a medical screening exam, stabilization, and an appropriate transfer of an unstable patient by a Medicare-participating hospital.

Sending hospital stabilizes; receiving accepts and has capacity; transfer uses qualified personnel and appropriate equipment.

Safety framework separating human error/at-risk behavior (coach/console) from reckless behavior (discipline), encouraging non-punitive reporting.

A transport adaptation of crew resource management (CRM) that flattens hierarchy so any crew member can voice a safety concern.

Situation, Background, Assessment, Recommendation — a structured handoff to prevent loss of critical information across transitions of care.

Weather check, weight/balance, equipment and oxygen check, and patient packaging before lift-off.

Rotor-wing (helicopter) = shorter range, scene access; fixed-wing (airplane) = longer interfacility range, often pressurized.

A pressurized cabin can request a lower cabin altitude to limit gas expansion and hypoxia for sensitive patients.

Tooth pain from trapped gas expanding under a filling or in a cavity during ascent (Boyle's law).

Ear pain/rupture from trapped gas changes; have the patient yawn/swallow (Valsalva) to equalize.

The time a hypoxic person can perform useful tasks at altitude before incapacitation.

The time from an O₂-supply interruption at altitude until purposeful activity is lost — shorter the higher you go.

The classic altitude hypoxia: low partial pressure of inspired O₂ reduces arterial oxygenation.

Tissues cannot use delivered oxygen (e.g., cyanide poisoning).

Inadequate blood flow/perfusion (e.g., shock) limits oxygen delivery despite adequate content.

Reduced oxygen-carrying capacity of blood (e.g., anemia, carbon monoxide).

Head-to-foot acceleration pools blood in the lower body, reducing cerebral perfusion.

Crews carry navigation, communication, signaling, and survival equipment for an off-airport landing.

Defined visibility/ceiling limits a flight must meet; the pilot aborts below them regardless of patient acuity.

Pre-flight calculation ensuring the aircraft is within safe loaded-weight and center-of-gravity limits.

Repeat-back confirmation of orders/messages so nothing is lost in the noisy cabin.

Preparation, Preoxygenation, Pretreatment, Paralysis with induction, Positioning, Placement with proof, Post-intubation management.

RSI preparation checklist: Suction, Oxygen, Airway equipment, Pharmacology, Monitors, End-tidal CO₂.

Continuous waveform end-tidal CO₂ — the gold standard for confirming and monitoring ET tube placement in a noisy, moving cabin.

Supplemental O₂ (e.g., nasal cannula) during the apneic phase of intubation to extend safe apnea time.

3 minutes of 100% O₂ (or 8 vital-capacity breaths) before RSI to build an oxygen reserve.

Depolarizing paralytic; fastest onset, short duration; causes potassium efflux.

Major burns/crush injury >24–72 h old, denervating disease, and hyperkalemia (risk of lethal K⁺ efflux).

Nondepolarizing paralytic used when succinylcholine is contraindicated; no K⁺ shift, longer duration — pair with sedation.

Dissociative induction agent that supports BP and bronchodilates — good for shock or bronchospasm.

Hemodynamically stable induction agent; transient adrenal suppression.

Sudden decline in a ventilated patient: Displacement, Obstruction, Pneumothorax, Equipment failure.

Low tidal volume (~6 mL/kg ideal body weight) with PEEP, used in ARDS to limit barotrauma.

Positive end-expiratory pressure — keeps alveoli open at end-expiration to improve oxygenation.

Allow a long expiratory time to avoid breath-stacking (auto-PEEP) and barotrauma.

pH 7.35–7.45, PaCO₂ 35–45 mmHg, HCO₃ 22–26 mEq/L, PaO₂ 80–100 mmHg.

Respiratory Opposite, Metabolic Equal — for matching pH to PaCO₂ (respiratory) or HCO₃ (metabolic).

Hypovolemic, cardiogenic, distributive, and obstructive.

Volume loss (hemorrhage, burns, dehydration); tachycardia, narrow pulse pressure, cool/clammy; treat with blood/balanced resuscitation.

Pump failure (often large MI); cold & wet, pulmonary edema, ↑lactate; treat with inotropes + treat the cause.

Pathologic vasodilation (septic, anaphylactic, neurogenic); ↓SVR; treat with fluids + vasopressors.

Mechanical block — tamponade, tension pneumothorax, massive PE; relieve the obstruction.

Distributive shock after spinal cord injury: hypotension WITH bradycardia and warm, dry skin (lost sympathetic tone).

Norepinephrine — titrated to keep the MAP $\geq$65 mmHg in distributive shock.

Keep the mean arterial pressure at 65 mmHg or higher.

Warm, balanced blood products (RBC/plasma/platelets) over large-volume crystalloid in hemorrhage.

Large-volume room-temperature crystalloid dilutes clotting factors and worsens hypothermia and acidosis.

VF and pulseless VT are shockable; PEA and asystole are not.

IV magnesium for polymorphic VT with a prolonged QT.

A pre-intubation airway-difficulty predictor based on visible oropharyngeal structures (I–IV).

Difficult-airway predictor: Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility.

Pressure on the cricoid (Sellick maneuver) — applied only if it improves the view; released if it hinders.

Backward-Upward-Rightward Pressure on the larynx to improve the glottic view during intubation.

Have a rescue plan: supraglottic airway (LMA/i-gel), bag-mask, and a surgical cricothyrotomy as the final option.

An emergency surgical airway through the cricothyroid membrane when 'cannot intubate, cannot oxygenate.'

A backup tube-confirmation device — turns gold with exhaled CO₂ — but waveform capnography is superior.

Good preoxygenation + apneic oxygenation extends the safe apnea period before desaturation.

Always pair a paralytic with adequate sedation/analgesia — a paralyzed patient can be awake and in pain.

Norepinephrine is a vesicant; prefer a central line and treat extravasation (phentolamine) to prevent necrosis.

Balanced 1:1:1 (RBC:plasma:platelets) component therapy in major hemorrhage.

Citrate in stored blood binds calcium → hypocalcemia; replace calcium during massive transfusion.

Trended to gauge tissue hypoperfusion and resuscitation adequacy in shock and sepsis.

$CO = HR \times SV$ — cardiac output is heart rate times stroke volume.

$MAP = DBP + \tfrac{1}{3}(SBP - DBP)$ — keep $\geq$65 mmHg in shock.

Rapid IV push (with a fast flush) for stable narrow-complex SVT; expect transient asystole.

Synchronized cardioversion for an unstable patient with a tachyarrhythmia and a pulse.

Atropine first, then transcutaneous pacing (or epinephrine/dopamine infusion).

A sudden rise in EtCO₂ during CPR suggests return of spontaneous circulation (ROSC).

Optimize oxygenation/ventilation, support BP, treat the cause, and consider targeted temperature management.

Hypothermia + acidosis + coagulopathy — each worsens the others in severe trauma.

The lethal triad PLUS hypocalcemia — four interrelated derangements that worsen hemorrhage.

Permissive hypotension, warm balanced blood products, warming, calcium replacement, and early TXA.

Keeping BP deliberately lower in uncontrolled hemorrhage until bleeding is controlled, to avoid dislodging clot.

Tranexamic acid — an antifibrinolytic given early in major hemorrhage to reduce clot breakdown and mortality.

Hypothermia blunts the clotting cascade and platelet function — warming directly fights the lethal triad.

Direct pressure, tourniquets, hemostatic dressings, and pelvic binders.

Scores consciousness 3–15: eye (1–4) + verbal (1–5) + motor (1–6).

A GCS $\leq$8 generally means the patient cannot protect the airway → intubate.

Preventable worsening of TBI from hypoxia and hypotension — avoid both at all costs.

Avoid hypoxia/hypotension, elevate the head ~30°, maintain normocapnia (no routine hyperventilation).

Late sign of raised ICP: hypertension with widened pulse pressure, bradycardia, irregular respirations → herniation.

Air trapped under pressure: hypotension, JVD, absent breath sounds, late tracheal deviation; expands at altitude (Boyle).

Needle decompression, then a chest tube — ideally placed before flight.

Sucking chest wound — apply a 3-sided occlusive dressing and watch for tension.

Three or more contiguous ribs fractured in two or more places → paradoxical movement + pulmonary contusion.

Hypotension + JVD + muffled heart sounds — an obstructive-shock emergency treated with pericardiocentesis.

A widened mediastinum with differential pulses — control HR/BP (beta-blockade) and transport rapidly.

An unstable pelvis can exsanguinate — apply a pelvic binder to tamponade bleeding.

Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia — emergency fasciotomy; do not elevate or ice.

Muscle breakdown releasing myoglobin (dark urine, ↑CK) → AKI; treat with aggressive IV fluids; common in crush injury.

Singed nasal hairs, soot, stridor, or facial burns → intubate EARLY before edema closes the airway.

Estimate size (rule of nines) and resuscitate (Parkland-type) titrated to urine output; keep the patient warm.

Suspect carbon monoxide and cyanide toxicity.

Limit spinal movement when injury is suspected by mechanism or exam during extrication and transport.

The energy and pattern of the event that predicts likely injuries and guides assessment.

Another name for the lethal triad: hypothermia, acidosis, and coagulopathy.

Controlling bleeding — the trauma priority (direct pressure, tourniquet, hemostatic dressing, binder).

For life-threatening extremity hemorrhage not controlled by pressure; note the time applied.

Avoid permissive hypotension in traumatic brain injury — the brain needs perfusion pressure.

$CPP = MAP - ICP$ — maintain CPP in TBI by supporting MAP and lowering ICP.

Mastoid bruising / periorbital bruising suggesting a basilar skull fracture.

CSF rhinorrhea/otorrhea (halo sign); avoid blind nasal tubes.

Arterial bleed (middle meningeal artery) with a lucid interval, then rapid deterioration; biconvex on CT.

Venous (bridging veins) bleed, crescent-shaped; common in elderly and anticoagulated patients.

Spinal shock = temporary loss of reflexes/function below the injury; neurogenic shock = hemodynamic (hypotension + bradycardia).

A T6-or-above SCI emergency: severe hypertension + bradycardia from a noxious stimulus (often a full bladder).

Any pleural air expands as the aircraft climbs (Boyle) — decompress before flight when possible.

Blood in the pleural space; dullness to percussion, decreased breath sounds, shock; chest tube + blood.

Bruised lung tissue causing hypoxemia that worsens over hours; supportive oxygenation/ventilation.

Focused Assessment with Sonography for Trauma — bedside ultrasound for free fluid (blood).

Burn surface estimate: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.

A circumferential burn can act as a tourniquet or restrict breathing → may need escharotomy.

Deep internal injury and rhabdomyolysis/dysrhythmias despite small external wounds; monitor the ECG.

Anticipate airway compromise and major vascular injury; control bleeding and secure the airway early.

Shield the eye (no pressure), keep the head elevated, and avoid increasing intraocular pressure.

ST elevation $\geq$1 mm in $\geq$2 contiguous leads (or new LBBB) from a fully occluded coronary artery.

Primary PCI door-to-balloon $\leq$90 min, or fibrinolytics if PCI is unavailable in time.

II, III, and aVF.

Obtain a right-sided ECG (V4R); RV infarct is preload-dependent, so AVOID nitroglycerin.

Nitroglycerin drops preload; the preload-dependent right ventricle then causes profound hypotension.

Reduce shear: lower heart rate and BP with a beta-blocker BEFORE any vasodilator.

IABP, Impella, and LVAD devices the flight nurse may transport — know alarms and assessment.

Last-known-well time — it drives thrombolytic and thrombectomy eligibility.

Time is brain — transport rapidly to a stroke-capable (ideally thrombectomy-capable) center.

A seizure $\geq$5 minutes (or repeated without recovery); first-line treatment is an IV benzodiazepine.

Head elevation ~30°, normocapnia, osmotic therapy as ordered; avoid hypoxia and hypotension.

Sudden dyspnea, pleuritic pain, hypoxia; massive PE causes obstructive shock; treat with anticoagulation/thrombolytics.

A marginally oxygenated pulmonary patient may need a higher FiO₂ or lower cabin altitude to avoid hypoxia.

Nitric oxide or epoprostenol may accompany severe hypoxemic patients in transport.

Glucose >250 mg/dL with ketosis and anion-gap acidosis (pH <7.3), Kussmaul breathing, fruity breath; usually type 1.

Extreme hyperglycemia (often >600, even >1,000), high osmolality, profound dehydration, minimal ketosis; older type 2.

IV fluids first → insulin infusion → potassium; no insulin if K⁺ <3.3 mEq/L.

Early cultures, broad-spectrum antibiotics, fluids, and vasopressors to keep the MAP $\geq$65 mmHg.

Hypotension, hypoglycemia, hyponatremia, hyperkalemia → give stress-dose hydrocortisone and fluids.

Intramuscular epinephrine.

Peaked T waves → widened QRS → sine wave → arrest.

Stabilize (IV calcium) → shift (insulin+glucose, beta-agonist, bicarb) → remove (diuretics, binders, dialysis).

No BPs, blood draws, or IVs in that arm; assess for a thrill and bruit.

The opioid antidote — reverses respiratory depression in opioid overdose.

'Not dead until warm and dead' — rewarm before declaring death; rewarm carefully (risk of afterdrop).

Core temp >40 °C with CNS dysfunction — a medical emergency; cool rapidly.

Sodium bicarbonate (for a widened QRS in tricyclic antidepressant toxicity).

Ischemic chest pain with a NORMAL troponin and no persistent ST elevation (no necrosis).

Elevated troponin with ST depression/T-wave inversion but no persistent ST elevation (partial occlusion).

Dyspnea, crackles, pink frothy sputum; treat with upright position, O₂/NIV, IV loop diuretic, and nitroglycerin.

Irregularly irregular, no P waves; rate/rhythm control and anticoagulation (CHA₂DS₂-VASc); cardiovert if unstable.

Delirium = acute, fluctuating, often reversible; dementia = gradual, progressive, irreversible.

Severe weakness with respiratory failure in myasthenia gravis — support ventilation.

Ascending paralysis that can cause respiratory failure; monitor vital capacity and the airway.

Severe hyperthyroidism: fever, tachycardia, agitation; supportive care, beta-blockade, and antithyroid therapy.

Severe hypothyroidism: hypothermia, bradycardia, hypotension, altered mental status; needs thyroid hormone + supportive care.

Large-bore access, fluids/blood, and rapid transport; upper (hematemesis/melena) vs lower (hematochezia).

Rising intra-abdominal pressure compromising perfusion and ventilation; may need decompression.

Severe epigastric pain to the back with elevated lipase; bowel rest, fluids, and pain control.

Prerenal (low perfusion), intrarenal (direct damage), postrenal (obstruction).

100% oxygen (or hyperbaric for severe cases); pulse oximetry can read falsely normal.

Hydroxocobalamin (Cyanokit); suspect in enclosed-space fires with lactic acidosis.

Hypoxia is the key problem — prioritize ventilation/oxygenation; watch for delayed pulmonary edema.

Immobilize the limb at heart level, remove constrictions, mark the swelling, and transport for antivenom.

Nitrogen bubbles from rapid ascent/diving (Henry's law); treat with 100% O₂ and recompression; keep cabin altitude low.

Hyperglycemia falsely lowers measured sodium; calculate corrected sodium to guide fluids.

A feared complication (especially in children) — avoid overly rapid glucose/osmolality correction.

Increased blood volume lets a patient lose ~30–35% before hypotension; the fetus may be in distress while maternal vitals look normal.

Position a pregnant patient (after ~20 weeks) tilted left to relieve aortocaval compression by the gravid uterus.

The gravid uterus compresses the aorta and IVC in a supine pregnant patient, reducing cardiac output.

Aggressive maternal resuscitation — treat the mother first to save the fetus.

Abdominal pain, vaginal bleeding, and uterine tenderness after trauma — a fetal/maternal emergency.

Magnesium sulfate.

Appearance, Pulse, Grimace, Activity, Respiration — each 0–2 (total 0–10) at 1 and 5 minutes.

It describes the newborn's condition but does NOT direct resuscitation (HR and breathing do).

Ventilation — newborns arrest from respiratory failure, unlike adults.

Within 30 s: warm, dry, stimulate, and position the airway.

Apnea or a heart rate below 100.

Steps to correct ineffective newborn PPV: Mask, Reposition, Suction, Open mouth, Pressure, Alternate airway.

Start at HR <60 despite effective PPV, coordinated 3:1 with breaths (90 compressions + 30 breaths/min).

Give if HR stays <60 despite effective PPV + compressions (IV/IO preferred); consider volume.

Weight-based dosing and length-based tools (e.g., a Broselow tape).

Children compensate well, then crash suddenly — hypotension is a LATE, ominous sign.

Atypical presentations (an MI may be fatigue/confusion), less reserve, and polypharmacy.

Anticoagulation makes even minor head trauma dangerous; high fragility-fracture risk.

Airway, vascular access, weight-based dosing, equipment weight limits, and positioning.

Aligning the ear with the sternal notch (head/shoulders elevated) improves intubation and ventilation in obese patients.

New hypertension + proteinuria after 20 weeks; can progress to seizures (eclampsia).

Hemolysis, Elevated Liver enzymes, Low Platelets — a severe preeclampsia variant.

Excessive bleeding after delivery (often uterine atony) — fundal massage, uterotonics, and resuscitation.

Umbilical cord precedes the fetus — relieve cord pressure (knee-chest/elevate the presenting part) and transport emergently.

Loss of deep tendon reflexes, respiratory depression; antidote is calcium gluconate.

Newborns lose heat fast (high surface area) — keep warm; cold stress worsens outcomes.

Common and dangerous in sick/premature newborns — check and treat glucose.

Immature lungs (surfactant deficiency), thermoregulation, and intraventricular hemorrhage risk.

Larger head/tongue, anterior larynx, narrow cricoid — position carefully and use correct-size equipment.

20 mL/kg isotonic crystalloid for shock, reassessing after each bolus.

Tachycardia is an early shock sign; hypotension is late and ominous.

A fast alternative when IV access fails — common in pediatric and adult resuscitation.

A modified (pediatric) GCS is used for preverbal children.

Multiple medications increase interaction and adverse-event risk; reconcile carefully.

Beta-blockers can blunt the tachycardic response to shock in older adults — don't be reassured by a 'normal' HR.

Anticipate a difficult airway and rapid desaturation; pre-oxygenate well and ramp the patient.

Use appropriate weight metric (ideal vs adjusted vs total body weight) for the specific drug.

Confirm stretcher/aircraft weight capacity and door/space constraints before accepting transport.