A trauma patient cannot maintain airway with bag-valve-mask ventilation after initial resuscitation. According to ATLS, what is the next recommended step?

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In trauma care, the airway must be protected and ventilated reliably. When a patient cannot be kept adequately ventilated with bag-mask ventilation after initial resuscitation, the next step is to establish a definitive airway. This means securing the airway with endotracheal intubation (typically using rapid sequence induction and in-line cervical spine stabilization) so ventilation is controlled and protected against aspiration. If intubation cannot be achieved, a surgical airway (cricothyrotomy or tracheostomy) is the fallback.

Delaying airway management until swelling subsides risks progressive hypoxia and deterioration. Relying on noninvasive ventilation isn’t appropriate in an unstable trauma patient with an insecure airway and potential airway obstruction. Continuing to attempt BVM without securing the airway does not address the fundamental need to protect the airway and ensure reliable ventilation.