While hiking, a 24-year-old woman was pinned from the waist down under a rock that collapsed on her. Upon your arrival, the patient is conscious and alert, and states that she can't feel her legs. She further tells you that she thinks she has been pinned for about 5 hours. She is breathing adequately and has stable vital signs. In addition to administering supplemental oxygen, you should:
A) start two large-bore IV lines of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs.
B) quickly remove the rock from her legs to restore distal neurovascular function, and administer a 20-mL/kg bolus of lactated Ringer's solution.
C) administer 2 mEq/kg of sodium bicarbonate followed by 25 g of 50% dextrose as you slowly and carefully remove the rock from her legs.
D) start at least one large-bore IV line and administer 2 to 4 L of normal saline before attempting to remove the rock from her legs.
Answer: A) start two large-bore IV lines of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs.
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