The smallest CFRN domain, at 15 items, and a larger one on the CTRN, at 23. Both cover pregnancy and delivery, neonates and children, older adults and patients with obesity; the CTRN adds positioning for each group and securement devices for children.
Obstetric: trauma, medical conditions, drug considerations, delivery and postpartum care.
Neonatal and pediatric: trauma, medical conditions, drug considerations; the CTRN adds transport securement devices.
Geriatric: trauma, medical conditions, drug considerations.
Bariatric: trauma, medical conditions, drug considerations, and transport considerations in the CFRN outline; positioning for every group in the CTRN outline.
Pregnancy on a stretcher
Position: once the uterus reaches the umbilicus, around 20 weeks, lying flat can compress the vena cava; the AHA's maternal resuscitation guidance uses manual left uterine displacement.
Blood gas norms shift: pregnancy lowers the normal PaCO2 to roughly 28–32 mmHg, so a value of 40 mmHg in a breathless pregnant patient suggests she is tiring.
Postpartum hemorrhage is a cumulative blood loss of 1,000 mL or more, or any blood loss with signs of hypovolemia, within 24 hours of birth, whatever the route of delivery (ACOG Practice Bulletin 183, 2017).
Carboprost and asthma: the same bulletin lists asthma as a contraindication to carboprost, so check the history before a second-line uterotonic is drawn up.
Neonates, children, older adults
Room air first for term newborns. The AHA and AAP neonatal resuscitation guidance begins term and late-preterm resuscitation in 21% oxygen and titrates by pulse oximetry.
Restraints in a ground unit. NHTSA's working-group recommendations (2012) on transporting children in ground ambulances describe restraint by the child's condition; read them alongside the securement devices your unit carries.
Normal vital signs in older adults. Beta-blockers, pacemakers and a stiff vasculature can hide shock behind a normal heart rate.
Bariatric transport joins clinical care to equipment limits: stretcher, door and aircraft weight limits, and positioning for breathing.
15 questions on special patients
0 of 15 attempted · 0 correct · 0 missed
Special Populations · 15 items
The transport nurse is caring for a 15-kg child with congenital adrenal hyperplasia who has vomited all day and is lethargic. BP 68/40 mmHg, glucose 45 mg/dL. Which hydrocortisone dose is MOST appropriate?
Answer and why, all 4 options
A vomiting, hypotensive child cannot absorb oral hydrocortisone; adrenal crisis needs the IV or IM route.
A stress dose of about 2 mg/kg (or 50–100 mg/m²) IV, about 30 mg here, treats adrenal crisis with hypotension and hypoglycemia.
150 mg is five times the stress dose of about 2 mg/kg (30 mg here) and more than the 100 mg adult dose.
3 mg is a physiologic maintenance-level dose, far too little for adrenal crisis with shock.
Item 565639
Special Populations · 15 items
The transport nurse is moving a patient at 33 weeks' gestation with preeclampsia with severe features on magnesium sulfate 2 g/h. En route, the patient develops dyspnea, crackles and SpO2 88% on 4 L/min. BP is 164/104 mmHg. Which order should the nurse anticipate?
Answer and why, all 4 options
Preeclampsia with pulmonary edema is treated with a loop diuretic, fluid restriction and BP control, while oxygen is given.
Methylergonovine raises BP and is contraindicated in hypertensive disorders of pregnancy.
Calcium gluconate reverses magnesium toxicity; nothing here points to it, and stopping magnesium removes seizure prophylaxis.
A fluid bolus worsens pulmonary edema in preeclampsia, where capillary leak and low oncotic pressure are already present.
Item 565969
Special Populations · 15 items
The transport nurse is moving a 9-year-old child with DKA, 5 hours into treatment. The child develops a new headache, becomes irritable and then drowsy, and the HR falls from 118 to 68 beats/min while the BP rises. Glucose is 260 mg/dL. Which intervention is MOST appropriate?
Answer and why, all 4 options
A saline bolus adds volume to a brain that is swelling, worsening cerebral edema.
An insulin bolus drops glucose and osmolality quickly, which contributes to cerebral edema in DKA.
Bicarbonate in pediatric DKA is linked to cerebral edema and does not treat the cause.
Headache, falling level of consciousness and bradycardia with rising BP during DKA treatment are signs of cerebral edema; mannitol (or hypertonic saline) and less fluid treat it.
Item 566195
Special Populations · 15 items
The transport nurse is caring for a laboring patient at 36 weeks gestation with a prior cesarean birth. The patient suddenly reports tearing abdominal pain; contractions stop, the fetal heart rate falls to 70 beats/min, fetal parts are easily palpable, and BP drops to 84/50 mmHg. Which condition is MOST likely?
Answer and why, all 4 options
A precipitous delivery advances labor rather than stopping contractions, and the mother does not become hypotensive.
Amniotic fluid embolism presents with sudden respiratory distress, hypoxia and DIC, not easily palpable fetal parts.
A prior cesarean scar, tearing pain, loss of contractions, fetal bradycardia and easily felt fetal parts point to uterine rupture.
Abruption causes pain and a firm, tender uterus, but the uterus stays intact, so fetal parts are not easily felt.
Item 1695912
Special Populations · 15 items
A 9-month-old infant with an upper respiratory infection is being flown in an unpressurized helicopter. The infant is MOST likely to have ear pain from barotitis media during which phase of flight?
Answer and why, all 4 options
On ascent, middle ear air expands and vents passively through the eustachian tube, so pain is uncommon.
On descent, rising cabin pressure must push air into the middle ear through a eustachian tube that is narrow and swollen in an infant with a cold, so pain occurs then.
A hover is at nearly constant altitude; the pressure change happens during the descent before it.
At steady cruise altitude pressure is stable, so there is no new gradient across the eardrum.
Item 1695922
Special Populations · 15 items
A transport team at a remote clinic assesses a G4P3 at 39 weeks' gestation with contractions every 2 minutes and a strong urge to push. The fetal head is crowning. The nearest obstetric unit is a 45-minute flight away. Which approach is MOST appropriate?
Answer and why, all 4 options
Tocolytics do not stop delivery when the head is crowning, and they risk hemorrhage after birth.
With the head crowning in a multipara, birth is minutes away; delivery in the clinic is safer than in a moving aircraft.
Delivering in a moving aircraft gives cramped space and poor access when complications arise; birth is imminent here.
Trendelenburg does not delay a crowning head and makes delivery and resuscitation harder.
Item 1882854
Special Populations · 15 items
Before lift-off for a patient in active labor with a known placenta previa, the flight nurse leads the pre-mission briefing. Which briefing item is MOST critical?
Answer and why, all 4 options
Adult airway gear alone ignores newborn resuscitation and hemorrhage, the two most likely emergencies.
One clinician cannot manage a bleeding mother and a newborn needing resuscitation at the same time.
Two patients need two planned leads: one for the mother and one for the newborn, with hemorrhage supplies staged for bleeding from the previa.
Delaying launch for a second team holds a laboring patient with previa in a facility without the needed care.
Item 1882857
Special Populations · 15 items
A patient with preeclampsia who delivered 1 hour ago develops heavy vaginal bleeding in flight. The fundus is boggy and above the umbilicus, and BP is 142/94 mmHg. Which intervention is MOST appropriate FIRST?
Answer and why, all 4 options
Holding uterotonics during active atonic bleeding lets hemorrhage continue during the flight.
Large crystalloid volumes dilute clotting factors and do not stop uterine bleeding.
Methylergonovine is contraindicated in a hypertensive patient with preeclampsia.
A boggy uterus means atony, the most common cause of postpartum hemorrhage; fundal massage and oxytocin come first.
Item 1882859
Special Populations · 15 items
During transport of an infant on VA-ECMO, the drainage (venous) pressure becomes more negative and circuit flow falls steadily. The tubing is chattering, and the heart rate and rhythm are stable. Which action is MOST appropriate FIRST?
Answer and why, all 4 options
A heparin bolus treats clot, but chatter with a negative drainage pressure points to inflow limitation, not thrombus.
A more negative drainage pressure with chattering tubing means the venous cannula is sucking against a vessel wall or there is too little volume; checking position and volume treats the cause.
Higher pump speed makes the drainage pressure more negative and worsens the chatter.
Clamping drainage and stopping sweep gas cuts ECMO support in a patient who depends on it.
Item 1882887
Special Populations · 15 items
A 14-kg child is in hypotensive hypovolemic shock from gastroenteritis. The child has a 22-gauge IV before transport. Which initial fluid bolus and delivery method are MOST appropriate?
Answer and why, all 4 options
140 mL is 10 mL/kg, and running it by gravity over 30 minutes is too slow for hypotensive shock.
280 mL is the right volume, but a gravity drip through a 22-gauge catheter over an hour is far too slow.
420 mL is 30 mL/kg as a single bolus, more than an initial bolus, and needs reassessment between aliquots.
20 mL/kg (280 mL) pushed by syringe over 5–10 minutes overcomes the resistance of a small catheter and delivers the bolus fast enough for hypotensive shock.
Item 1882915
Special Populations · 15 items
An 82-year-old takes metoprolol, lisinopril, alprazolam, warfarin and glyburide and took all home medications 2 hours before departure. Thirty minutes after lift-off, BP is 78/42 mmHg and HR 52 beats/min. Glucose is 118 mg/dL, the skin is warm, and there is no sign of bleeding. Which explanation is MOST likely?
Answer and why, all 4 options
Metoprolol peaks within 1–2 hours and lisinopril adds its effect over several hours, with alprazolam adding to it; with the blunted baroreflex of older age they lower BP while the beta-blocker holds the rate down.
Bleeding is a real risk with warfarin, but warm skin, no bleeding source and timing that matches the dose point to drug effect, not volume loss.
Low cabin humidity causes slow insensible loss over hours; it does not drop BP this far within 30 minutes.
A glucose of 118 mg/dL rules out hypoglycemia as the cause.
Item 1941239
Special Populations · 15 items
A community hospital requests air transfer of a patient at 31 weeks' gestation in active preterm labor with severe preeclampsia. Under EMTALA, which requirement must be met before the patient leaves?
Answer and why, all 4 options
For a patient in labor who is not stabilized, EMTALA requires a written physician certification that the medical benefits of transfer outweigh the risks.
EMTALA allows transfer of a woman in labor when a physician certifies that the benefits outweigh the risks; delivery first is not required.
Law enforcement has no role in EMTALA transfer requirements.
EMTALA does not use a liability waiver; the patient's informed consent to transfer is documented instead.
Item 1882866
Special Populations · 15 items
A 31-week preterm neonate is being moved by helicopter in a transport isolette. Cabin noise exceeds 90 dB. Which measure BEST protects the neonate from this flight stressor?
Answer and why, all 4 options
Neonatal earmuffs or ear protection lower the sound reaching an immature cochlea and reduce stress responses during a loud rotor-wing flight.
Sedation does not reduce noise exposure to the inner ear and adds respiratory risk in a preterm infant.
A blanket cuts light, not the noise level that matters, and it blocks observation of the neonate.
The isolette hood dampens little cabin noise and can amplify low-frequency sound and vibration.
Item 9730007
Special Populations · 15 items
A patient at 30 weeks' gestation with pneumonia is flown at a cabin altitude of 6,000 ft. Her SpO2 is 93% on 2 L/min, and the fetal heart rate is 150 beats/min. Which SpO2 target should guide her oxygen?
Answer and why, all 4 options
A 90% floor accepts a maternal PaO2 near 60 mmHg, too low for fetal oxygen delivery.
There is no oxygen-toxicity concern at these levels, and 85% would starve the fetus.
Fetal oxygen supply depends on maternal arterial oxygen near the steep part of the curve, so maternal SpO2 is kept at 95% or above.
An 88–92% range is used for chronic hypercapnic lung disease and leaves the fetus short of oxygen.
Item 9730042
Special Populations · 15 items
A 6-kg infant with bronchiolitis is on high-flow nasal cannula for transport. Which flow rate matches the usual weight-based setting?
Answer and why, all 4 options
24 L/min is 4 L/kg/min, double the usual setting, and risks gastric distension and barotrauma.
2 L/min is a low-flow cannula rate that gives none of the positive pressure or washout of high flow.
Infant high-flow protocols use about 2 L/kg/min, so 6 kg × 2 = 12 L/min.
40 L/min is an adult high-flow rate, far too much for a 6-kg infant.
Item 9730044
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Injured mothers and children in the trauma center
Injury care for pregnant patients, children and older adults once they reach a trauma center, and burns in every age group, is taught on TCRN special populations. This page keeps the transport side: delivery en route, positioning and securement, and the equipment limits of the vehicle.
Neonatal and pediatric patients are one group in the special populations domain, covering trauma, medical conditions and drug considerations. The outline does not name a specific course such as NRP.
What does the CTRN add for children?
Positioning for each special population, and transport securement devices for neonates and children.