Mary ann, a medical assistant, works in a busy primary care office operated by two physicians, dr. johnson and dr. laskar. it is saturday, so the staff consists of just mary ann, dr. johnson, and another medical assistant named valerie. on saturdays, the office is only open until 1: 00 p. m., but it is already 11: 00 a. m. and the office has been extremely busy. valerie has not had time to do her morning checks yet, and the reception room is full of crying children.

as mary ann is looking over the schedule, she hears a commotion out front, followed by sudden quiet, and then valerie’s call for . when mary ann gets to the reception room, there is a worried-looking man bent over a 35-year-old woman who is supine on the floor. she appears to be awake, but her eyes are closed and she is grimacing. she seems very short of breath. her face is profusely diaphoretic and pale. “she had some indigestion last night when she went to bed,” the man says, “and she did not sleep much last night. this morning when she got up to go to the bathroom, she stated she was very nauseated.”

when asked, the lady responds with her name and says she is having some really sharp pain in her right lower abdomen. she points to it with one finger. dr. johnson is notified immediately to further evaluate the woman. as instructed, mary ann and valerie the woman into a wheelchair and wheel her into an examining room. she immediately complains of dizziness and increased pain, and now her breathing becomes extremely labored. she cannot seem to talk at all in response to questions.

what is your response?
what is your clinical impression of this woman?
in what position should she be placed?
what kind of history would you be especially curious about?
what kind of initial treatment would you administer?