At the skate park, a 10-year-old male fell, struck his head, not wearing a helmet. He is responsive to painful stimuli only, with a large hematoma to the back of his head. After stabilizing the head and opening the airway, you determine that his breathing is slow and irregular and his pulse is slow and bounding. You should:

• A. Assist ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.
• B. Do nothing until your partner arrives.
• C. Remove helmet immediately and ventilate.
• D. Focus on controlling the bleeding and delay airway management.

Answer: (A)

In a child with a head injury from a fall, the top priorities are airway and breathing while keeping the spine protected. The slow, irregular breathing indicates inadequate ventilation, so you must provide assisted ventilations (using a bag-valve-mask with high-flow oxygen) to support oxygen delivery and remove the risk of hypoxia. At the same time, protect the cervical spine with full spinal precautions since a traumatic brain injury often accompanies potential neck injuries; immobilize the head and neck and keep the patient on a rigid backboard as you prepare for transport. If vomiting occurs, suction the airway to keep it clear while you ventilate. This scenario calls for rapid transport to a trauma center because the combination of head injury and compromised airway breathing elevates the risk of deterioration.

Leaving the helmet on is appropriate here because removing it can worsen spinal injury and delay airway management; ventilations can be performed with the helmet in place, and airway clearance is prioritized first. Waiting for a partner or focusing solely on bleeding would delay essential airway support, which is critical for preventing brain injury from hypoxia.