A 58-year-old woman fell and landed face-first on a concrete sidewalk. She is conscious, but confused. Her skin is pale, cool, and clammy; her radial pulses are weak and rapid; and her blood pressure is 72/54 mm Hg. Further assessment reveals crepitus to her left cheekbone. After administering high-flow oxygen, you should:
A. perform a detailed secondary assessment, immobilize her entire spine, and establish IV access.
B. place her in a sitting position on the stretcher, insert a saline lock, and reassess her blood pressure.
C. apply a cervical collar only, establish two large-bore IV lines, and administer 2 liters of normal saline.
D. immobilize her entire spine, establish at least one large-bore IV line, and give a 20-mL/kg crystalloid bolus.
Answer: D. immobilize her entire spine, establish at least one large-bore IV line, and give a 20-mL/kg crystalloid bolus.
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