A patient presents to the emergency department reporting persistent vaginal bleeding 90 minutes after delivering her second child. Her recorded vital signs include a blood pressure of 85/55 mmHg, heart rate of 120 bpm, and respiratory rate of 24/min. What should be the first step in managing this patient?
Administer uterotonic medications
Administer intravenous isotonic crystalloids
Perform an immediate bedside ultrasound to evaluate for retained products of conception
Directly administer 4 units of packed red blood cells