A 35-year-old G4P3 woman at 39 weeks gestation is in active labor when she suddenly develops severe dyspnea, cyanosis, and hypotension. Her vital signs are: BP 70/40 mmHg, HR 140 bpm, RR 32/min, O2 sat 85%. She becomes unresponsive and develops seizure-like activity. The fetal heart rate shows severe bradycardia at 60 bpm. What is the nurse's highest priority action?

Activating the emergency response team is the highest priority due to the rapid progression and need for multidisciplinary care in ASP. Other actions like oxygen or IV access are important but secondary to immediate team mobilization.

Clinical Presentation and Recognition
This clinical scenario depicts a classic, catastrophic presentation of an amniotic fluid embolism (AFE). The patient is a multiparous woman in active labor who experiences a sudden onset of severe dyspnea, cyanosis, and profound hypotension (BP 70/40 mmHg). This rapidly progresses to cardiovascular collapse, unresponsiveness, and seizure-like activity, with concurrent fetal bradycardia (FHR 60 bpm). As described in the literature, AFE is a "rare and life-threatening obstetric emergency" characterized by the sudden entry of fetal material into the maternal circulation, triggering "severe cardiorespiratory collapse" ^[1][2]. The triad of acute hypoxia, cardiovascular collapse, and coagulopathy is a hallmark, though the initial presentation is overwhelmingly cardiorespiratory in nature.

Prioritization of Nursing Actions
In a rapidly deteriorating maternal code situation, the nurse's priority is to activate the emergency response system and secure immediate, high-level assistance. The rationale is grounded in the complexity of AFE management, which requires a multidisciplinary team for simultaneous, life-saving interventions.

- Why not option 1 (Prepare for emergency cesarean section)? While delivery is critical for fetal survival and may aid maternal resuscitation by relieving aortocaval compression, preparing the operating room is a secondary step. The immediate need is for the personnel and equipment to manage a maternal cardiac arrest. The physician team must be present to make the decision for a perimortem cesarean section.
- Why not option 2 (Administer high-flow oxygen)? This is a critical intervention for the profound hypoxemia (O2 sat 85%). However, it is a single task within a larger resuscitation bundle. The nurse can apply oxygen while calling for help, but calling for help must be the first action to ensure that other simultaneous interventions (intubation, chest compressions, medication administration) can follow immediately.
- Why not option 3 (Establish IV access and begin fluid resuscitation)? Fluid resuscitation is essential for the profound hypotension. However, in the setting of a suspected AFE, aggressive fluid management must be balanced against the risk of pulmonary edema and right ventricular failure. More importantly, this task requires additional hands. The nurse cannot leave the patient to start a second IV line without first summoning the team that will manage the airway, perform compressions, and prepare medications.

Underlying Pathophysiology and Clinical Correlation
The prioritization of calling for help is directly linked to the pathophysiology of AFE. The entry of amniotic fluid and fetal components into the maternal pulmonary vasculature causes a biphasic reaction. The initial phase involves acute pulmonary vasoconstriction, leading to right ventricular failure, severe hypoxemia, and cardiovascular collapse, exactly as seen in this patient ^[1]. This is often followed by left ventricular failure and a consumptive coagulopathy ^[2]. The case reports highlight that AFE "poses great challenges to clinical diagnosis and targeted intervention" because it is a multisystem crisis from the outset ^[1]. No single nurse can simultaneously manage the airway, circulation, and impending coagulopathy. The "highest priority action" is therefore to initiate the chain of survival by activating the emergency response team, which brings the necessary multidisciplinary expertise and equipment to the bedside to address the concurrent respiratory, cardiac, and hematologic emergencies.