FP-C flight paramedic certification and how to earn it

A 140-kg man (ideal body weight 70 kg) requires RSI. Which succinylcholine dose is most appropriate?

1. 105 mg

   105 mg is 1.5 mg/kg of the 70-kg ideal weight, the scaling used for rocuronium or tidal volume; for succinylcholine it risks a partial block and poor intubating conditions.
   Check
2. 70 mg

   70 mg is only 1 mg/kg of ideal weight, an underdose twice over: the wrong weight and the bottom of the per-kilogram range.
   Check
3. 210 mg

   Succinylcholine is dosed on total body weight at about 1.5 mg/kg, and 1.5 × 140 kg gives 210 mg; obese patients carry more extracellular fluid and plasma cholinesterase, so a lean-weight dose falls short.
   Check
4. 280 mg

   280 mg works out to 2 mg/kg of total weight, the figure used for infants and small children; in an adult it adds side-effect exposure without a better block.
   Check

Select an answer to record it. The card then marks the key and opens the reasoning under every choice.

A patient with a type B aortic dissection is on an esmolol infusion. HR is now 58, but BP remains 150/90. What is the most appropriate next step?

1. Add a vasodilator to SBP 140–160 mmHg

   The drug class is right but the goal is not: a systolic of 140–160 mmHg leaves enough wall stress to extend the tear.
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2. Accept the current BP of 150/90

   Rate control is only half of the goal; a systolic of 150 still drives propagation of the dissection flap.
   Check
3. Increase esmolol until HR is below 40

   The heart-rate goal is already met at 58; pushing below 40 causes bradycardic hypoperfusion and barely touches the residual hypertension.
   Check
4. Add a vasodilator to SBP 100–120 mmHg

   With the heart rate already under 60, the remaining target is a systolic pressure near 100–120 mmHg, so a vasodilator such as nicardipine or clevidipine is added on top of the beta-blocker to cut shear on the aortic wall.
   Check

During transport of a 5-year-old with a splenic laceration, which change is the EARLIEST indicator that hemorrhage is progressing?

1. Rising heart rate

   Children compensate for blood loss with tachycardia and vasoconstriction, so a climbing heart rate is the first sign that the spleen is still bleeding.
   Check
2. Falling systolic BP

   An injured child holds systolic pressure until a large share of blood volume is gone; hypotension is a late finding that signals decompensation.
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3. Decreasing GCS

   A decreasing GCS follows a drop in cerebral perfusion, which comes after the compensatory tachycardia has been present for some time.
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4. Falling SpO2

   SpO2 reflects gas exchange in the lungs, not circulating volume, and usually stays normal through early hemorrhage.
   Check

Minutes after a large-volume bupivacaine nerve block, a patient has a seizure followed by a wide-complex bradycardia at 42/min and BP 64/30. Midazolam has stopped the seizure. What is the most appropriate specific treatment?

1. Lidocaine 1.5 mg/kg IV push

   Lidocaine is itself a local anesthetic, so it adds to the sodium-channel blockade that is producing the wide-complex bradycardia.
   Check
2. Lipid emulsion 1.5 mL/kg IV

   A 20% lipid emulsion bolus of about 1.5 mL/kg, followed by an infusion, creates a lipid sink that pulls bupivacaine off cardiac sodium channels; it is the specific therapy once the seizure is controlled and the heart is failing.
   Check
3. Vasopressin 40 units IV

   Vasopressin is avoided in local anesthetic toxicity because it worsens outcomes; pressor support uses small epinephrine doses instead.
   Check
4. Propofol 1 mg/kg IV bolus

   Propofol carries far too little lipid to act as an antidote, and its myocardial depression and vasodilation would deepen the shock.
   Check