IBSC FP-C
Checked against IBSC sources. Published .Start free practiceStudy All · IBSC FP-C quick referenceFlight Physiology
Flight Physiology
Share of the exam4 to 8%
Tables3
Tested facts1
| Law | What it explains |
|---|---|
| Boyle's | Trapped gas expands on ascent: vent the colostomy bag before flight and burp it during, and watch the endotracheal cuff, air splint and IV bag |
| Charles's | Volume relates to temperature |
| Dalton's | The partial pressure of oxygen falls with altitude even though the percentage of oxygen is unchanged |
| Fick's | Diffusion across a membrane |
| Henry's | Gas coming out of solution |
| Altitude or figure | Meaning |
|---|---|
| 3,000 to 8,000 feet | Starting physiologic altitude of a patient already on supplemental oxygen, whose haemoglobin is already saturated |
| Above 15,000 feet | Supplemental oxygen alone is no longer sufficient |
| About 44,800 feet | Body fluids boil at ambient pressure: survival requires a sealed cabin or full pressure suit |
| 79 to 70 per cent saturation | The disturbance stage of hypoxia; blackout is the end point |
| Stressor | Figure |
|---|---|
| Cabin noise | Around 70 dBA |
| Vibration | 1 to 12 Hz range |
| Flicker vertigo | Light flickering at about 4 to 20 cycles per second |
| Temperature lapse | About 3 to 5 degrees Fahrenheit per thousand feet |
Study All · IBSC FP-C quick referenceSafety and Transport
Safety and Transport
Share of the exam6 to 10%
Tables2
Tested facts1
| Item | Figure |
|---|---|
| Governing regulation | 14 CFR Part 135 |
| Duty limit | No more than 16 hours on duty within any 24-hour span |
| Pilot hours | Typically 2,000 total with at least 1,500 in a helicopter, plus an instrument rating |
| EMS crash fatality rate | About 33 per cent, against about 14 per cent for non-EMS crashes; pilot incapacitation is more than ten times as likely in EMS crashes |
| Flight following | Real-time radio contact or tracking updates at least every 15 minutes |
| Scene coordinates | At least two independent sets for the same location |
| Requirement | Purpose |
|---|---|
| HTAWS | Helicopter terrain awareness and warning systems, against controlled flight into terrain |
| Instrument rating for every pilot-in-command | A safer transition to instrument flight if weather closes in |
| FAA-approved preflight risk analysis tool | Systematic weighing of weather, fatigue and mission complexity before accepting a flight |
| Personal flotation devices | Worn by all crew during overwater flights |
Study All · IBSC FP-C quick referenceAirway, Anesthesia, and Analgesics
Airway, Anesthesia, and Analgesics
Share of the exam13 to 17%
Tables3
Tested facts4
| Setting | Value and rationale |
|---|---|
| Baseline PEEP | Roughly 5 cm H2O: increases functional residual capacity and helps wash out physiologic dead space |
| Recruitment maneuver | 40 to 50 cm H2O for 30 to 40 seconds; the benefit is usually short-lived |
| I:E for obstruction | 1:4 or 1:5 |
| Inverse-ratio ventilation | Poorly tolerated, which is why neuromuscular blockade is often given with it |
| Raising PEEP in a pressure-targeted mode | Decreases driving pressure (delta P), which can drastically reduce delivered tidal volume |
| Agent | Profile |
|---|---|
| Etomidate | Haemodynamically stable and cerebroprotective, but a single dose can suppress the adrenal cortisol response for 6 to 8 hours or longer |
| Ketamine | Dissociative with analgesia and amnesia, bronchodilation, minimal respiratory depression, preserved airway reflexes and muscle tone; raises heart rate and blood pressure, useful in the hypotensive asthmatic |
| Propofol | Rapid on, rapid off, but a significant cardiovascular depressant with exaggerated hypotension in the volume depleted; prolonged high-dose infusion risks propofol-related infusion syndrome |
| Parameter | Rule |
|---|---|
| Tidal volume in ARDS | 4 to 6 mL/kg of PREDICTED body weight, the ARDS Network strategy that improved mortality |
| Plateau pressure | Below 30 cm H2O with poor compliance; below 20 cm H2O for normal adult lungs |
| Driving pressure | Plateau minus PEEP; keep it below 15 cm H2O |
| Severe ARDS | Berlin definition: PaO2 to FIO2 ratio below 100 (mild 200 to 300, moderate 100 to 200) |
| Auto-PEEP | Set external PEEP about 75 per cent below the measured auto-PEEP value |
Study All · IBSC FP-C quick referenceCardiac
Cardiac
Share of the exam11 to 15%
Tables5
Tested facts3
| Item | Value |
|---|---|
| Calibration | 0.04 second per small box, 10 mm per millivolt |
| Infarction criteria | At least 1 to 2 mm of ST elevation in at least two contiguous leads |
| Lead aVL on the hexaxial reference | Minus 30 degrees, with the reciprocal at plus 150 |
| Hyperkalaemia threshold | Potassium above 5.5 mEq/L |
| Wide complex thresholds | Greater than 160 ms with LBBB morphology; greater than 140 ms with RBBB morphology |
| Vessel | Territory and consequence |
|---|---|
| Right coronary artery | SA node in 85 to 90 per cent of people, so an RCA occlusion can silence it: sinus bradycardia and blocks with inferior infarction |
| Posterior descending | Arises from the RCA in 80 to 85 per cent; supplies the inferior wall, septum and posteromedial papillary muscle |
| Left anterior descending | Anterior wall, interventricular septum and BOTH bundle branches, so anteroseptal infarction brings conduction blocks and cardiogenic shock |
| Item | Rule |
|---|---|
| Troponins | Rise 2 to 6 hours after injury, peak 12 to 16 hours; troponin I stays up 5 to 10 days, troponin T 5 to 14 days |
| Myoglobin | Fast but abandoned for ACS: skeletal muscle injury and renal failure also raise it |
| IV nitroglycerin | Start 10 mcg/min, titrate in 10 mcg increments, ceiling 200 mcg/min |
| Transfer antiplatelets | No fibrinolysis given or planned: aspirin 324 mg with ticagrelor 180 mg orally before departure |
| Fibrinolysis exclusion | A systolic difference greater than 15 mm Hg between arms suggests dissection |
| Disturbance | Signature |
|---|---|
| Hyperkalaemia | Tall, narrow, peaked T waves starting above 5.5 mEq/L, then widened PR and QRS, loss of P waves and a sinusoidal pattern |
| Hypokalaemia | A prominent U wave after the T wave is the commonest finding; it mainly raises torsades susceptibility |
| Hypocalcaemia | Prolonged ST segment with apparent QTc lengthening; clinically, depressed contractility, wheezing, stridor, bradycardia, crackles, an S3 and tetany |
| Magnesium | Stabilises the myocardial membrane, works with potassium and opposes calcium |
| Item | Rule |
|---|---|
| Phlebostatic axis | Fourth intercostal space, mid-chest, level of the atrium and aortic root; each inch of transducer error shifts readings 1.86 mm Hg |
| Square-wave test | More than two oscillations after a fast flush means underdamping: falsely high systolics, fixed by removing bubbles and keeping tubing under 48 inches |
| End expiration | Read at the PEAK of the baseline in spontaneous breathing, the VALLEY in mechanical ventilation |
| PCWP on high PEEP | Above 10 cm H2O of PEEP, subtract 1.5 mm Hg per 5 cm H2O from the measured wedge; document both values |
| Arterial line contraindications | Extremity ischaemia, site infection, Raynaud disease, prior vascular surgery at the site |
Study All · IBSC FP-C quick referenceMedical Emergencies
Medical Emergencies
Share of the exam11 to 15%
Tables10
Tested facts2
| Item | Value |
|---|---|
| Hyperosmolar hyperglycaemic state | Serum osmolality above 320 mmol/kg with hyperglycaemia but without significant ketoacidosis |
| DKA resolution | Return of the anion gap to normal, not the glucose alone |
| Sodium correction rate | 4 to 6 mEq/L per 24 hours; faster risks harm |
| pH threshold for specific measures | Below 6.90 |
| Alkalinisation target | Urine pH 7 to 8.5, with hypokalaemia extremely common and watched closely |
| Normal oxygen extraction ratio | 25 per cent; it must rise substantially to compensate for falling delivery |
| Poison | Rule |
|---|---|
| Caustic ingestion | Small amount of water or milk; do NOT induce vomiting, do NOT neutralise |
| Acid versus alkali | Acids cause coagulation necrosis, limiting depth; alkalis cause liquefactive necrosis, penetrating deeper |
| Hydrocarbon | Induced vomiting may increase pulmonary toxicity through aspiration |
| Non-selective beta blockade | Beta-1 and beta-2 effects together: bronchospasm and hypoglycaemia included |
| Dabigatran | Idarucizumab inactivates it; dialysis is an alternative |
| Toxidrome | Picture and treatment |
|---|---|
| Sympathomimetic | Tachycardia, hypertension, agitation, hyperthermia, dilated pupils and WET, diaphoretic skin; benzodiazepines for sedation and seizure control |
| Anticholinergic | The same autonomic picture with HOT, DRY skin, ileus, delirium and urinary retention from muscarinic blockade by antihistamines, TCAs, atropine or jimson weed; severe cases may receive physostigmine, only after toxicologist consultation |
| Cholinergic | SLUDGEM secretions with bronchorrhoea and bronchospasm from cholinesterase inhibitors; atropine in doses far above ACLS dosing plus pralidoxime, with airway and ventilation a high priority |
| Opioid | Best viewed as a subset of the sedative-hypnotic syndrome; both are treated with airway, ventilation and circulatory support, but only opioid syndrome has a reliable specific antidote |
| Category | Rule |
|---|---|
| Not adsorbed | Iron, lithium, certain heavy metals, hydrocarbons and alcohols |
| Contraindicated | Caustics, which charcoal does not adsorb and whose imaging it obscures; hydrocarbons, because vomiting after charcoal risks aspiration |
| Gut dialysis | Charcoal lowers levels of theophylline, phenytoin, carbamazepine, salicylates and digoxin even after systemic absorption |
| Whole-bowel irrigation | Iron and heavy metal ingestions, plus large sustained-release or enteric-coated ingestions and body packers or stuffers |
| Gastric lavage | Only within 1 hour of a life-threatening ingestion; it is invasive, delays charcoal or an oral antidote, and may push toxin further along the gut |
| Poisoning | Rule |
|---|---|
| TCA with QRS above 100 ms | Up to 34 per cent seizure risk and up to 14 per cent life-threatening arrhythmia risk; alkalinise the serum with sodium bicarbonate |
| Beta blocker | Glucagon 5 to 10 mg IV then an infusion, acting through its own receptor independent of the blocked beta receptor; refractory cases get high-dose insulin with glucose and IV lipid emulsion, with ECMO at some centres |
| Calcium channel blocker | IV calcium first; methylene blue is noted specifically for amlodipine toxicity |
| Salicylate dialysis | Level above 100 mg/dL, or above 90 mg/dL with impaired renal function |
| Hydrogen peroxide | Concentrations above 9 per cent can generate enough gas to cause systemic air embolism |
| Category | Rule |
|---|---|
| Droplet | Particles larger than 5 micrometres travelling short distances, as with pertussis; surgical mask for the crew |
| Airborne | Droplet nuclei of 5 micrometres or smaller that stay suspended over distance and time: TB, measles, varicella, viral haemorrhagic fevers; N95 and ideally a negative-pressure environment |
| Type | Mechanism and example |
|---|---|
| I | Immediate, IgE on mast cells and basophils degranulating within minutes: atopy and anaphylaxis |
| II | Cytotoxic: IgG or IgM binds a cell-surface antigen and complement lyses the cell: transfusion reactions, haemolytic disease of the newborn |
| III | Circulating antigen-antibody complexes deposit in tissue |
| IV | Delayed, cell mediated by macrophages and T cells, onset hours to days: poison ivy contact dermatitis |
| Rule | Value |
|---|---|
| Winters formula | Expected PaCO2 = (1.5 x HCO3) + 8, plus or minus 2; a measured PaCO2 above the prediction means a concurrent respiratory acidosis |
| Metabolic alkalosis compensation | PCO2 rises about 0.7 mm Hg per 1 mmol/L rise in bicarbonate; urgent treatment when bicarbonate exceeds 40 or pH exceeds 7.55 |
| Base excess | Normal minus 2 to plus 3 mEq/L; deficits are mild to minus 6, moderate to minus 15, severe beyond |
| Compensation | Never overshoots |
| Item | Rule |
|---|---|
| Rightward curve shift | Increased PaCO2, increased 2,3-BPG, increased temperature, decreased pH: oxygen unloads more readily |
| Carboxyhaemoglobin | Pulse oximetry and calculated saturation both count it as if it were oxyhaemoglobin, giving falsely reassuring values |
| Lactate | Above 2 mmol/L means inadequate perfusion; it responds slowly over hours, so serial values reveal the trend, and a rising lactate is perhaps the most ominous sign in septic shock |
| Sensitivity | A highly sensitive test such as D-dimer rules disease out; its frequent false positives make it poor at ruling in |
| Item | Rule |
|---|---|
| Massive transfusion | More than 10 units of red cells in 24 hours; give PRBCs, plasma and platelets 1:1:1 |
| Whole blood | Reserved for acute loss of at least 25 per cent of blood volume; simpler and more concentrated than components, with no demonstrated outcome advantage |
| Emergency uncrossmatched | Type O, Rh-negative blood or plasma, carrying no A, B or D antigen |
| Universal recipient | Type AB patients make no anti-A or anti-B antibodies |
| Fresh frozen plasma | Needs ABO compatibility but not Rh matching, must run within 24 hours of thawing, and its citrate binds calcium, so watch for hypocalcaemia |
| Febrile reactions | Driven by donor white cells; prevented with leukocyte-reduced products |
| TRALI versus TACO | TRALI is neutrophil activation in the lung producing an ARDS-like injury; TACO is volume overload in cardiac or pulmonary disease |
Study All · IBSC FP-C quick referenceNeurological
Neurological
Share of the exam9 to 13%
Tables2
Tested facts1
| Finding | Lesion |
|---|---|
| Fixed dilated pupil, ptosis, eye down and out | Oculomotor (CN III) palsy, classically from the uncus herniating over the tentorium and compressing the nerve |
| Eye resting higher, vertical diplopia worst looking down and in | Trochlear (CN IV) palsy of the superior oblique |
| Eye cannot move laterally, cross-eyed look, horizontal diplopia | Abducens (CN VI) palsy: the unopposed medial rectus pulls the globe inward |
| Loss of the corneal blink | Afferent CN V, efferent CN VII: the reflex arc tests the pons |
| Tongue deviates to one side | Hypoglossal (CN XII) lesion on the SAME side the tongue points, pushed there by the intact genioglossus |
| Bleed | Signature |
|---|---|
| Epidural | Middle meningeal artery torn by a temporal blow; unconsciousness, a LUCID INTERVAL, then deterioration as renewed arterial bleeding strips the dura; lens-shaped on CT |
| Acute subdural | Torn bridging veins; crescent-shaped high-attenuation collection, symptoms within 24 hours |
| Chronic subdural | Manifests beyond two weeks and is fluid only, with slowly progressive headache, slowed cognition and drowsiness |
| Diffuse axonal injury | Shearing of white matter tracts in the corpus callosum, brainstem and cerebellum: immediate unconsciousness, prolonged confusion, no mass lesion on early CT |
Study All · IBSC FP-C quick referenceTrauma/Burn
Trauma/Burn
Share of the exam10 to 14%
Tables3
Tested facts1
| Item | Value |
|---|---|
| TXA | Greatest mortality benefit within 3 hours: 1 gram bolus, then an infusion |
| Normal saline caution | Large volumes cause hyperchloraemic metabolic acidosis |
| Platelets | Stored at room temperature under constant agitation, shelf life about 5 days |
| Pelvic fractures | Approximately 60 to 70 per cent from motor vehicle crashes |
| Splenic flow | About 5 per cent of circulating blood volume filters through every minute |
| Urine output target | 0.5 to 1.0 mL/kg/h |
| Fat embolism syndrome | 69 per cent fracture-associated, about half tibial; 31 per cent from soft tissue without fracture |
| Class III haemorrhage | Roughly 1,500 mL, with 500 to 1,000 mL as the adjacent threshold |
| Anticoagulant | Reversal |
|---|---|
| Warfarin | Four-factor prothrombin complex concentrate, carrying factors II, VII, IX and X, plus vitamin K |
| Dabigatran | Idarucizumab, with dialysis as the fallback |
| Factor Xa inhibitors (apixaban, rivaroxaban) | Andexanet alfa; four-factor PCC is also used in practice |
| Unfractionated heparin | Protamine |
| Fracture | Estimated loss |
|---|---|
| Rib | 125 mL |
| Radius or ulna | 250 to 500 mL |
| Humerus | 500 to 750 mL |
| Tibia or fibula | 500 to 1,000 mL |
| Femur | 1,000 to 2,000 mL |
Study All · IBSC FP-C quick referenceMaternal Fetal and Neonatal
Maternal Fetal and Neonatal
Share of the exam5 to 9%
Tables1
Tested facts2
| Pattern | Rule |
|---|---|
| Variable deceleration | Abrupt onset, short duration, shape varying contraction to contraction: umbilical cord compression |
| Early versus late | Both are gradual; the early nadir coincides with the contraction peak (head compression), the late nadir follows the peak |
| Prolonged deceleration | An abrupt drop lasting 2 to less than 10 minutes |
| Acceleration at or beyond 32 weeks | At least 15 beats above baseline for at least 15 seconds |
| Acceleration before 32 weeks | The threshold drops to at least 10 beats for at least 10 seconds |
Study All · IBSC FP-C quick referencePediatric
Pediatric
Share of the exam6 to 10%
Tables1
Tested facts1
| Item | Rule |
|---|---|
| Racemic epinephrine in epiglottitis | Contraindicated: it can worsen swelling |
| Corticosteroids in asthma | Take about 4 to 6 hours: complement, not replace, the immediate agent |
| Inhaled corticosteroids | For children older than 18 months with a strong family history of asthma or atopy, continued only on response |
| Calcium in hyperkalaemia | Stabilises the myocardial membrane |
| Hypocalcaemia from hyperphosphataemia | Correcting the calcium rapidly is the wrong move |
| First-degree block in a child | PR above about 0.16 second |
| Monitoring leads | Never at the level of the diaphragm: use the lower abdomen or thighs |
| Brudzinski sign | Avoided where cervical spine injury is suspected; blood volume about 800 mL appears as a figure |
Study All · IBSC FP-C quick referenceProfessional Considerations
Professional Considerations
Share of the exam4 to 8%
Tables1
Tested facts0
| Category | Definition and response |
|---|---|
| Human error | An unintentional slip anyone similarly placed could have made: treated as a SYSTEM failure to correct, not punished |
| At-risk behaviour | A conscious shortcut whose risk is underestimated, such as habitually skipping a required independent pump check: coach and retrain |
| Reckless behaviour | Consciously ignoring a known, required safety step: accountability applies |
Sources this sheet is checked against
- Critical Care Transport (Jones & Bartlett, 3rd Edition), flight physiology
- Critical Care Transport (Jones & Bartlett, 3rd Edition), stresses of flight
- Critical Care Transport (Jones & Bartlett, 3rd Edition), air medical safety
- Critical Care Transport (Jones & Bartlett, 3rd Edition), aircraft fundamentals and flight physiology
- Critical Care Transport (Jones & Bartlett, 3rd Edition), airway management
- Critical Care Transport (Jones & Bartlett, 3rd Edition), mechanical ventilation
- Critical Care Transport (Jones & Bartlett, 3rd Edition), respiratory emergencies and airway management
- Critical Care Transport (Jones & Bartlett, 3rd Edition), critical care pharmacology
- Critical Care Transport (Jones & Bartlett, 3rd Edition), ventilation
- Critical Care Transport (Jones & Bartlett, 3rd Edition), electrocardiography
- Critical Care Transport (Jones & Bartlett, 3rd Edition), haemodynamic monitoring and mechanical circulatory support
- Critical Care Transport (Jones & Bartlett, 3rd Edition), electrophysiology and infarct recognition
- Critical Care Transport (Jones & Bartlett, 3rd Edition), electrophysiology and acute coronary syndromes
- Critical Care Transport (Jones & Bartlett, 3rd Edition), electrophysiology and arrhythmias
- Critical Care Transport (Jones & Bartlett, 3rd Edition), electrophysiology, electrolytes and cardiac drugs
- Critical Care Transport (Jones & Bartlett, 3rd Edition), pacemakers and defibrillators
- Critical Care Transport (Jones & Bartlett, 3rd Edition), haemodynamic monitoring
- Critical Care Transport (Jones & Bartlett, 3rd Edition), resuscitation, shock and heart failure
- Critical Care Transport (Jones & Bartlett, 3rd Edition), mechanical circulatory support
- Critical Care Transport (Jones & Bartlett, 3rd Edition), laboratory analysis and diagnostic studies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), endocrine and metabolic emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), infectious disease, toxicology and abdominal emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), toxicologic emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), infectious and communicable diseases
- Critical Care Transport (Jones & Bartlett, 3rd Edition), endocrine emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), gastrointestinal and genitourinary emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), resuscitation, shock and blood products
- Critical Care Transport (Jones & Bartlett, 3rd Edition), gastrointestinal and environmental emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neurologic emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neurologic assessment
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neuroanatomy and neurologic monitoring
- Critical Care Transport (Jones & Bartlett, 3rd Edition), traumatic brain injury
- Critical Care Transport (Jones & Bartlett, 3rd Edition), stroke and cerebrovascular emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neurologic emergencies and spinal injury
- Critical Care Transport (Jones & Bartlett, 3rd Edition), trauma
- Critical Care Transport (Jones & Bartlett, 3rd Edition), burns
- Critical Care Transport (Jones & Bartlett, 3rd Edition), obstetric emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neonatal transport
- Critical Care Transport (Jones & Bartlett, 3rd Edition), obstetric and gynecologic emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), neonatal emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), paediatric critical care
- Critical Care Transport (Jones & Bartlett, 3rd Edition), children with special health care needs
- Critical Care Transport (Jones & Bartlett, 3rd Edition), pediatric emergencies
- Critical Care Transport (Jones & Bartlett, 3rd Edition), professional issues
- Critical Care Transport (Jones & Bartlett, 3rd Edition), legal and ethical issues
- Critical Care Transport (Jones & Bartlett, 3rd Edition), patient safety
- Critical Care Transport (Jones & Bartlett, 3rd Edition), introduction and overview of critical care transport
- Critical Care Transport (Jones & Bartlett, 3rd Edition), medical-legal issues
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