A 5-year-old involved in a high-speed motor vehicle collision is being transported by helicopter. The initial assessment reveals gurgling respirations, a heart rate of 150 bpm, and pale, cool skin. There is no obvious external hemorrhage. Which of the following is the most critical initial intervention?
In pediatric trauma, the primary survey follows the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) sequence. Gurgling respirations indicate a partially obstructed airway, which is an immediate life threat that must be addressed first. While the patient also shows signs of shock (tachycardia, pale/cool skin), establishing a patent airway is the priority. Without a clear airway, all other resuscitation efforts, such as fluid administration, will be ineffective. Therefore, suctioning the airway is the most critical initial intervention.
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