What initial step should be taken if there is a significant bleed with a fracture?

In the case of a significant bleed associated with a fracture, controlling the bleed is the initial crucial step. This is because severe bleeding can lead to shock and further complicate the patient's condition, particularly in situations where a fracture has caused damage to blood vessels or external injuries.

Before taking any further measures, such as applying a tourniquet or performing other interventions, it's essential to ensure that hemorrhage control is prioritized. This may involve direct pressure on the wound, elevation, or other bleeding control methods. Once the bleeding is managed, appropriate attention can be given to the fracture itself and the overall condition of the patient.

The other options, although they may be relevant in different contexts, do not address the immediate need to control active bleeding. Starting CPR would only be indicated if the patient is unresponsive and not breathing, while reassessing the patient's condition would come after the initial bleed control has been managed. Applying a tourniquet could be necessary in some cases of severe bleeding, but it is not the first action when direct pressure can be applied to effectively control the bleeding.