CFRN Basics Practice Questions (20 Flashcards)

Implied Consent (Emergency Doctrine). This doctrine assumes a reasonable person would consent to life-saving treatment if they were able. It applies when a patient is physically/mentally unable to provide informed consent (e.g., unconsciousness, intoxication) and a life-threatening condition exists. CFRN Tip: BCEN emphasizes that implied consent is limited to interventions necessary to preserve life or limb. Documentation must clearly state the clinical findings justifying the emergency (e.g., Patient GCS 6, unable to protect airway) and the inability to obtain express consent.

Generally, yes. In many jurisdictions, pregnant minors or minor parents are considered emancipated for medical decision-making. Emancipated minors have the same legal rights as adults to consent to or refuse treatment. CFRN Tip: Know the triggers for emancipation: marriage, military service, financial independence (court-ordered), or pregnancy/parenthood. If the minor is emancipated, the flight nurse must respect their refusal if they have clinical capacity. Distractor: Mature minor status is often a judicial determination, whereas Emancipation is a legal status.

1) Assessment of capacity (A&O, no intoxication), 2) Discussion of the specific risks of refusal (including death/permanent disability), 3) Discussion of benefits of treatment/transport, and 4) The patient's stated reason for refusal. CFRN Tip: Simply having a patient sign an AMA form is insufficient. The narrative documentation must prove the patient was fully informed of the worst-case scenario and had the mental capacity to make that choice. BCEN looks for documentation of the informed part of the refusal.

**Occlusive Skin Wrap (Polyethylene/Plastic Wrap).** **Rationale:** For infants <29-32 weeks, an occlusive wrap (without drying the infant first) is the gold standard to prevent **Evaporative** and **Convective** heat loss. **Clinical Reasoning:** Preterm infants have a high surface-area-to-mass ratio and thin, permeable skin (low stratum corneum development), leading to massive transepidermal water loss (TEWL). **Exam Strategy:** Distinguish between drying the term infant vs. wrapping the preterm infant. For ELBW/VLBW, do NOT dry the body; wrap immediately and place a hat.

**To prevent/reverse pulmonary vasoconstriction and right-to-left shunting.** **Rationale:** Cold stress triggers the release of norepinephrine, which causes peripheral vasoconstriction (to conserve heat) but also causes **pulmonary vasoconstriction**. This increases pulmonary vascular resistance (PVR), leading to a return to fetal circulation patterns (PDA/PFO shunting), worsening hypoxia and acidosis. **Clinical Reasoning:** While hypoglycemia is critical, the respiratory collapse from pulmonary hypertension is the most immediate life threat in severe cold stress. Rewarm slowly (0.5°C/hr) to avoid rapid vasodilation and subsequent hypotension.