A 24-year-old gravida 1, para 0 female presents to the emergency department with a positive home pregnancy test and the acute onset of lower abdominal pain, right shoulder pain, and vaginal spotting. The pain is severe and woke her from sleep. She rates the pain as 8/10. She is a nurse and has stayed home from work the last three days due to fever, chills, and cough. She describes the cough as productive of yellow sputum. She has pain in her chest with coughing. She denies nausea, vomiting, or urinary symptoms. Her last menstrual period was six weeks ago.