A 17 year old G1P0 Woman at 39 weeks gestation presents to labor and delivery reporting a gush of blood-tinged fluid approximately five hours ago and the onset of uterine contractions shortly thereafter. She reports contractions have become stronger and closer together over the past hour. The fetal heart rate is 140 to 150 with accelerations and no decelerations. Uterine contractions are recorded every 2-3 minutes. A pelvic exam reveals that the cervix is 4 cm dilated and 100 percent effaced. Fetal station is 0. After walking around for 30 minutes the patient is put back in bed after complaining of further discomfort. She requests an epidural. However, obtaining the fetal heart rate externally has become difficult because the patient cannot lie still. What is the most appropriate next step in the management of this patient?

When a patient is incapacitated, providers are required to follow any instructions outlined ina. an advanced care directiveb.patient educational materialsc. a willd. a consent form

What is the objective ethical ideal

A35-year-old woman comes to the ed complaining of chest pressure. she has had such episodes intermittently over the last 5 years, usually when sleeping, but over the last year she has had more frequent severe symptoms that are occasionally associated with severe migraine headaches. the pain is midsternal and is described as pressure that extends as a band around her chest. the ed physician is initially dubious that the pain is cardiac in origin, because the woman has no coronary disease risk factors. an ecg, however, shows 2mm st-segment elevation and inverted t waves in leads v1 through v5 and 1mm st-segment depression in leads ii, iii, and avf. before the cardiologist arrives in the ed, the patient's ecg has returned to normal. this repeat normal ecg is obtained after the administration of aspirin, nitroglycerin, morphine, and oxygen. which of the following is most likely for these findings? - diffuse intimal thickening with focal areas of atherosclerotic narrowing - intermittent thrombus formation and lysis in the left anterior descending artery - intermittent thrombus formation and lysis in the right coronary artery - plaque rupture and thrombus formation in the left anterior descending artery - transiently increased coronary vascular tone in the right coronary artery