A 2-year-old girl fell from a second-story window, unresponsive with slow, irregular respirations and blood draining from the mouth and nose. The rapid scan reveals no gross injuries. The airway management should be:

• A. Open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.
• B. Intubate immediately without suction.
• C. Delay airway management until full assessment.
• D. Remove the airway and observe.

Answer: (A)

In a pediatric trauma patient who is unresponsive with irregular respirations and blood in the airway, the priority is to secure and maintain a patent airway while protecting the spine and providing oxygen. Start with a jaw-thrust maneuver to open the airway without moving the neck, which helps minimize potential cervical spine injury. Then clear the airway of blood and secretions by suctioning the mouth and nose to remove the obstruction and reduce aspiration risk. If the child remains unresponsive with a poor airway, place an oropharyngeal airway to keep the airway open and support ventilation. Begin bag-mask ventilation to provide oxygen and support breathing while preparing for a definitive airway if needed. Intubating immediately without suction can be hazardous because blood and secretions may block the view and lead to aspiration, and delaying airway management in this scenario increases the risk of hypoxia. The combined approach of opening the airway, clearing it, maintaining patency with an oral airway, and ventilating with a bag-mask device best stabilizes the child in this urgent setting.