A 27-year-old female, Jessica, comes to the emergency room with horrible abdominal pain. She is pregnant but not sure how far along she is but thinks 36 weeks. She had no prenatal care and has a history of cocaine use. The patient is disheveled and alone when she arrives.

The nurse tells the patient, “I need to see if I can get a fetal heart rate.” The patient is out of control screaming, “it hurts.” The nurse asks, “where does it hurt, is it radiating to your back?” The nurse assesses the abdomen and notes it to feel really firm. The patient continues to say, “I dont feel well. This hurts so bad.” The nurse also notes some blood, which is bloody show. The nurse asks, “Jessica, when was the last time you used cocaine?” The patient responds “I did this morning but it was my first time in a long time.” The nurse tells her “I found the heart rate, it is about 100 bpm”

The nurse turns the patient to the the left side and tells her, “I’m going to put oxygen on you because this extra oxygen will go to the baby and help the heart rate. We will also start a fluid bolus.” The patient states, “My stomach just hurts so bad.” The nurse feels the stomach and notes it to feel very rigid and boardlike.