Content List
The CFRN^® exam contains, but is not limited to, the following items.

Single System Emergencies
Cardiopulmonary (27 Items)

• Obtain 12-lead ECG
• Evaluate characteristics of chest pain
• Initiate and manage noninvasive transcutaneous cardiac pacemaker
• Interpret 12-lead ECG
• Determine need for and perform cardiopulmonary resuscitation
• Recognize pericardial tamponade
• Manage transvenous pacemaker
• Initiate fibrinolytic infusion
• Perform cardioversion/defibrillation
• Auscultate heart sounds
• Initiate monitoring and interpret ECG rhythm strips
• Initiate ACLS protocols
• Identify patients who are candidates for fibrinolytic agents
• Assist with pericardiocentesis
• Assess for neck vein distention
• Assess peripheral pulses and capillary refill
• Initiate PALS protocols
• Manage IABP during transport
• Perform pericardiocentesis

GI/GU AND OB EMERGENCIES (11 items):

• Insert and irrigate NG/OG tubes
• Inspect, auscultate, percuss, and palpate the abdomen
• Assess for flank tenderness and ecchymosis
• Perform neonatal resuscitation
• Assess fetal heart tones (Doppler)
• Perform emergency delivery
• Position a patient who has a prolapsed cord during labor
• Position a pregnant patient for uterine displacement
• Determine risk for delivery during transport
• Manage OB hypertensive disorders
• Manage neonates during transport
• Massage uterine fundus postpartum
• Manage vaginal bleeding/drainage
• Palpate for uterine contractions and fetal movement
• Interpret fetal monitoring strips
• Initiate and manage tocolytic therapy

MAXILLOFACIAL AND ORTHOPEDIC EMERGENCIES (8 items):

• Assess for upper respiratory distress/difficulty
• Assess for maxillofacial trauma
• Inspect oropharynx
• Manage ocular emergencies
• Reduce orthopedic injury
• Apply a traction splint
• Preserve amputated body part for reimplantation
• Manage pelvic instability
• Immobilize injured extremities
• Assess neurovascular status of injured or immobilized extremity (e.g. compartment syndrome)

NEUROLOGICAL EMERGENCIES (17 items):

• Perform cranial nerve assessment
• Assess drainage from ears and nose for blood and/or cerebrospinal fluid
• Perform or maintain full spinal immobilization
• Assess level of consciousness/mental status
• Assess seizure activity and initiate seizure precautions
• Evaluate reflexes (e.g. DTRs and clonus)
• Manage increased intracranial pressure
• Identify patients at risk for increased intracranial pressure
• Assess for nuchal rigidity
• Manage ventilation for a patient with suspected head injury
• Assess sensation and motor function
• Monitor intracranial pressure monitor devices

MULTI-SYSTEM EMERGENCIES
Environmental Emergencies (9 items)

• Manage fluid resuscitation for burn injury
• Measure/restore core body temperature
• Determine degree and extent of burn injury
• Evaluate decontamination of patient after exposure to hazardous materials
• Manage heat/cold related emergencies
• Plan measures for treating hazardous materials exposure
• Perform escharotomy
• Manage decompression sickness

General/Medical Emergencies (9 items)

• Assess/manage hematological disorders
• Initiate isolation precautions
• Identify and manage symptoms of hypoglycemia or hyperglycemia
• Assess risk of communicable disease transmission/exposure
• Assess patient for signs of envenomation
• Identify and manage fever
• Assess patient's fluid status
• Maintain patients who are potential organ/tissue donors

PATIENT MANAGEMENT
Patient Care (12 items)

• Interpret laboratory results
• Perform bedside laboratory testing (e.g., glucose, Hgb/Hct)
• Manage pain
• Evaluate a chest x-ray
• Apply/manage patient restraints
• Evaluate cervical spine x-rays
• Perform primary and secondary surveys
• Determine priority of patient care management
• Plan priorities of patient care management
• Evaluate patient response to interventions (e.g. medications, procedures)
• Initiate use of vasoactive drugs
• Calculate and titrate intravenous medication infusions
• Determine care based on age/weight parameters
• Monitor arterial line pressure
• Assess pulmonary artery (Swan Ganz) waveforms
• Monitor trends in blood pressure
• Plan care according to hemodynamic parameters
• Monitor central venous pressure readings
• Calculate appropriate fluid resuscitation for the pediatric patient
• Plan care based on developmental stages and age appropriate considerations
• Plan care based on cultural considerations
• Manage patient with delayed consequences of trauma (e.g. DIC, SIRES, MODS, ARDS)
• Develop transport diagnosis/impression based on assessment
• Determine death

Advanced Airway Care (9 items)

• Determine treatment plans based on colormetric end-tidal CO2 results
• Manage patients based on continuous capnography (wave form)
• Select appropriate measures to provide an airway (e.g. basic and advanced)
• Determine treatment plans based on pulse oximetry values
• Manage mechanical ventilation
• Perform a needle cricothyrotomy
• Perform oral intubation
• Choose device for oxygen delivery (e.g. nasal cannula, mechanical ventilator, mask)
• Perform nasal intubation
• Perform rapid sequence induction intubation
• Manage patients with surgical airway (cricothyrotomy and tracheostomy)
• Suction airway
• Insert nasal and/or oral airway
• Ventilate patient using a bag-valve-mask device
• Maintain neuromuscular blockade with sedation
• Facilitate airway management using alternative airway devices (e.g. LMAs, Combitube, bougie)
• Manage BiPAP
• Perform a surgical cricothyrotomy

Respiratory (7 items)

• Evaluate the patient's response to oxygen therapy
• Interpret results of arterial blood gas studies
• Maintain chest tube and drainage system
• Assess for abnormal breathing patterns
• Assess for inhalation injury
• Perform needle thoracostomy
• Administer nebulizer treatment
• Assess for pulsus paradoxus
• Inspect, palpate, percuss, and auscultate chest
• Manage chest wall injury
• Develop plan of care based on mechanism of injury
• Perform tube thoracostomy

Shock/Trauma (7 items)

• Assess and manage shock
• Administer blood products
• Monitor urinary output
• Perform rapid volume resuscitation
• Initiate ATLS/TNATC protocols
• Perform intraosseous placement
• Perform Trauma Score assessment
• Control visible hemorrhage
• Apply dressings to wounds
• Assess for soft tissue injury
• Manage patient based on type of shock
• Place a central intravenous line

Substance Abuse/Toxicological (3 items)

• Determine need for medication antagonist in an overdose situation
• Perform gastric emptying for toxic substance ingestion
• Plan measures for treating complications of toxic ingestion/inhalation/exposure
• Consult information resources about management of poisoning
• Recognize patients with drug overdose
• Identify substance abuse patients at risk for acute withdrawal symptoms

Transport Considerations (6 items)

• Assess and manage violent patient behavior
• Manage patient transport stressors
• Determine necessity for diversion
• Determine appropriate mode of transport (i.e., rotor, ground, fixed wing)
• Determine emergent versus non-emergent transport status (e.g. lights and sirens, code 3)
• Plan for treatment of effects due to altitude

SAFETY ISSUES
Safety (9 items)

• Assist in safe transport vehicle operation
• Perform vehicle decontamination and disposal of biohazardous waste
• Secure equipment in the transport vehicle
• Secure patient in the transport vehicle
• Manage crew transport stressors
• Communicate with EMS personnel
• Manage radio communication operations (e.g., frequencies)
• Report patient's condition to receiving staff
• Teach pre-hospital care workers to prepare a landing zone for helicopter
• Ensure security of aircraft at landing areas
• Assist with extrication
• Assist with flight following
• Assist with navigation

Disaster Management (3 items)

• Triage patient care during a disaster
• Implement steps of disaster plan
• Participate in a plan for mass casualties
• Participate in a plan for the effects of weapons of mass destruction

Survival (4 items)

• Train for transport vehicle emergencies
• Ensure safety of team and patient(s) in post-crash situation
• Participate in emergency operations plan
• Operate emergency locator transmitter (ELT)

PROFESSIONAL ISSUES
Legal (3 items)

• Notify authorities of reportable situations
• Evaluate patient's capacity to refuse treatment
• Ensure preservation evidence for legal/forensic situations
• Assess for signs of abuse
• Recognize legal requirements for transport (e.g. EMTALA, HIPPA)
• Provide documentation of transport care

Organizational Issues (3 items)

• Participate in conflict resolution
• Participate in critical incident stress management
• Participate in quality assurance/improvement activities
• Evaluate applicability of published evidenced-based research to practice

Patient/Community Education (3 items)

• Inform patients/families regarding procedures/patient condition
• Provide public education
• Provide transport safety briefing to patient/family member prior to transport
• Provide support to family after patient death
• Participate in continuing education/inservice
• Orient new staff to work responsibilities

• CFRN Certification Brochure (PDF)