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: The correct answer is D because during an allergic reaction, mast cells degranulate, releasing histamines and other inflammatory mediators into the bloodstream. This leads to vasodilation, increased vascular permeability, and smooth muscle contraction, causing symptoms like itching, hives, and difficulty breathing. Choice A is incorrect because mast cells do not retain vasoactive amines; they release them. Choice B is incorrect as there is no hypermetabolic state associated with an allergic reaction. Choice C is incorrect because anaerobic metabolism is not a typical response to an allergic reaction.

Correct Answer: C

Rationale: The correct next step is to perform endotracheal intubation (Choice C). In this scenario, the patient's presentation with a GCS of 6, dilated pupil, and contralateral weakness indicates significant neurological compromise likely due to increased intracranial pressure. Endotracheal intubation is crucial to protect the airway and ensure adequate oxygenation and ventilation in such critical conditions. Administering medications or performing diagnostic tests like a CT-scan (Choice A), decadron (Choice B), or mannitol (Choice D) should be secondary to securing the airway and stabilizing the patient's condition.

Correct Answer: C

Rationale: The correct answer is C: Severe maxillofacial fractures. These fractures can lead to airway compromise due to obstruction by displaced bone fragments or soft tissue swelling. Definitive airway management is crucial in these cases to ensure adequate oxygenation. Facial lacerations (A) may require suturing but do not necessarily indicate the need for a definitive airway. Repeated vomiting (B) can be managed with positioning and antiemetics, not always requiring an airway intervention. Sternal fracture (D) may cause pain and difficulty breathing but does not directly impede the airway, making it less likely to necessitate definitive airway management.

Correct Answer: C

Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness because it typically does not directly affect brain function or consciousness. Shock (A), head injury (B), and impaired oxygenation (D) are more likely to cause a depressed level of consciousness in this patient population due to their direct impact on brain perfusion, injury, and oxygen delivery, respectively. Hyperglycemia, although an important consideration in the critically ill patient, is not a primary driver of altered consciousness in the setting of multisystem trauma.

Correct Answer: B

Rationale: The correct answer is B: Insert a definitive airway. In a patient with a GCS of 8, airway management is a priority. Inserting a definitive airway ensures proper oxygenation and ventilation during the CT scan, reducing the risk of hypoxia or respiratory compromise. This step takes precedence over giving more sedative drugs (A), as ensuring adequate oxygenation is critical in a patient with altered mental status. Inserting a multilumen esophageal airway (C) is not indicated in this scenario, as it is primarily used for airway management during surgery. Requesting a lateral cervical spine film (D) is not necessary before a CT scan in this case, as securing the airway takes precedence over ruling out cervical spine injury.