Question

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 1

The correct response to the woman's condition after a fall, showing signs of shock, is to immobilize her spine, establish IV access, and administer fluid resuscitation with a crystalloid bolus.

Step-by-step explanation:

After administering high-flow oxygen to a 58-year-old woman who fell and sustained injuries, including signs of shock and crepitus to her left cheekbone, the appropriate next step is to immobilize her entire spine, establish at least one large-bore IV line, and give a 20-mL/kg crystalloid bolus. This response corresponds to option D. The woman's condition, described as being conscious but confused with pale, cool, clammy skin, weak and rapid radial pulses, and low blood pressure, indicates shock, likely due to her injuries and possible internal bleeding. Immediate IV fluid resuscitation with a crystalloid solution is necessary to improve her circulatory volume and blood pressure, while spinal immobilization is standard precautionary measure to prevent exacerbating any potential spinal injury from her fall.