You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation?

Correct Answer: C

Rationale: The correct answer is C: Supine hypotension. The patient's symptoms of dizziness, weakness, extreme nausea, cool and pale skin, along with a low blood pressure of 80 mmHg systolic and high heart rate of 126-130 bpm, suggest a decrease in blood flow to the heart and brain. In pregnancy, lying supine can compress the vena cava, reducing venous return and cardiac output, leading to supine hypotension. The other choices are incorrect: A) Uterine rupture typically presents with severe abdominal pain and signs of shock, B) Spontaneous abortion would present with vaginal bleeding and abdominal pain, and D) Placenta previa usually presents with painless vaginal bleeding.

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: D

Rationale: The correct answer is D: Initiate full resuscitation efforts including advanced cardiac life support, and contact medical control. Rationale: 1. Patient is pulseless and apneic, indicating cardiac arrest. 2. Legal DNR order does not apply in this scenario as patient's collapse is sudden and not anticipated. 3. The priority is to provide immediate life-saving measures. 4. Advanced cardiac life support increases chances of successful resuscitation. 5. Contacting medical control ensures appropriate guidance and documentation. Summary: A: Waiting for approval could delay critical interventions. B: Stopping resuscitation based solely on the legal DNR order is inappropriate in this emergency. C: Allowing the family to override the legal order puts the patient at risk and is not recommended.

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.