During your primary assessment of a 19-year-old unconscious male with severe head trauma, you observe rapid, irregular, shallow respirations and bloody secretions draining from the mouth and nose. You should:

• A. Pack nostrils.
• B. Suction the oropharynx for up to 15 seconds.
• C. Immobilize his spine and transport immediately.
• D. Assist ventilations with a Bag-Valve-Mask.

Answer: (B)

The main idea here is airway clearance in a trauma patient with signs of airway obstruction. When someone is unconscious after head trauma and you observe rapid, irregular, shallow respirations plus blood secretions in the mouth and nose, the airway is compromised and there’s a high risk of aspiration. The first step is to clear the airway so air can move in and out effectively. Suctioning the oropharynx for a brief period (around 15 seconds) removes blood and secretions that are blocking the airway, restoring patency without causing prolonged hypoxia. Maintain spinal immobilization during this maneuver to protect a potential cervical injury. After clearing the airway, reassess the patient’s breathing; if ventilation remains inadequate, you would proceed with assisted ventilation using a bag-valve-mask. Immediate transport is important, but not at the expense of airway clearance—the airway must be clear first to optimize ventilation and reduce aspiration risk.