An unresponsive patient after an ATV crash is wearing a full-face helmet. There is blood oozing from the mouth, jaw clenched, SpO2 86% and gurgling. What should you do?

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When a trauma patient is unresponsive with signs of airway obstruction (blood and gurgling) and a full-face helmet, the priority is to clear the airway while keeping spine immobilization intact. A full-face helmet protects the airway and neck and is best left in place if possible because removing it can delay airway management and risk spinal movement. The quickest, most effective way to address the obstruction is to suction the mouth through the helmet. This directly removes blood and secretions that are causing the gurgling and hypoxia, which is evident by the SpO2 of 86%.

After suctioning, you can reassess and provide ventilation as needed. Turning the patient onto the side may help drainage in some cases, but it risks losing immobilization and delaying airway clearance in this scenario. Attempting bag-mask ventilation without first clearing the airway is likely to be less effective, since secretions can occlude the seal and continue to impede ventilation.