You are called to assist an adult female with a possible allergic reaction. You arrive to find a 22-year-old patient who is just beginning to have difficulty breathing. She has itching, urticaria, and hives after a bee-sting. During the possible allergic reaction, what is occurring at the cellular level?

Correct Answer: D

Rationale: Rationale: 1. Mast cells play a key role in allergic reactions by releasing histamines and other inflammatory mediators. 2. When triggered by an allergen like a bee-sting, mast cells degranulate, releasing histamines and serotonin. 3. Histamines cause vasodilation and increased vascular permeability, leading to itching, hives, and urticaria. 4. Serotonin contributes to smooth muscle contraction and bronchoconstriction, leading to difficulty breathing. 5. Therefore, choice D is correct as it accurately describes the cellular events in an allergic reaction. Summary: A, B, and C are incorrect because they do not accurately depict the cellular processes involved in an allergic reaction. A does not mention degranulation, B focuses on a hypermetabolic state unrelated to allergies, and C refers to anaerobic metabolism which is not the primary mechanism in allergic reactions.

Correct Answer: C

Rationale: The correct next step is to perform endotracheal intubation (Choice C) in this scenario. Given the presentation of a motor vehicle crash with a GCS of 6, dilated pupil, and contralateral weakness, it indicates severe head trauma causing impending airway compromise and the need for airway protection. Intubation will secure the airway, ensure adequate oxygenation, and prevent the risk of aspiration. Choice A (CT-scan of head) is not the immediate priority as the patient's airway needs to be secured first. Choice B (Decadron) is not indicated for acute head trauma and may even worsen brain injury. Choice D (Mannitol) may help reduce intracranial pressure, but securing the airway takes precedence in this critical situation.

Correct Answer: C

Rationale: Correct Answer: C - Severe maxillofacial fractures Rationale: 1. Severe maxillofacial fractures can compromise the airway due to obstruction or displacement of structures. 2. Airway management is crucial in trauma patients to ensure adequate oxygenation and ventilation. 3. Maxillofacial fractures can lead to airway compromise rapidly, requiring a definitive airway intervention. 4. Other choices (A: Facial lacerations, B: Repeated vomiting, D: Sternal fracture) may not directly impact the airway to the same extent as severe maxillofacial fractures.

Correct Answer: C

Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, the primary causes of depressed consciousness are related to perfusion and oxygenation. Hyperglycemia, while a concern, is less likely to directly cause a depressed level of consciousness compared to shock, head injury, and impaired oxygenation. Hyperglycemia may lead to symptoms like confusion or weakness, but it typically does not result in a significant decrease in consciousness level. Therefore, in the context of a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness.

Correct Answer: B

Rationale: Correct Answer: B - Insert a definitive airway Rationale: 1. Patient has a low GCS of 8, indicating impaired consciousness and airway protection. 2. Obesity can further complicate airway management during sedation. 3. Inserting a definitive airway ensures adequate oxygenation and ventilation. 4. CT scan can cause respiratory depression, necessitating secure airway before transfer. 5. Multilumen esophageal airway is not indicated as it does not secure the airway. 6. Sedative drugs should be used cautiously due to the risk of respiratory depression. 7. Lateral cervical spine film is not necessary before CT scan in this scenario.