Aspiration of gastric contents is certainly a possibility, as the child has been unconscious with an unprotected airway for some length of time. Although in the adult you are more likely to aspirate into the right chest, in children the main bronchi leave the trachea at the same angle and aspiration is equally likely on both sides.

Still, there is almost certainly an element of pulmonary contusion here given the external bruising. However you recognise that there is no intra-thoracic condition requiring immediate intervention. His respiratory rate is rising, and even you know that the increased resistance to flow caused by the tracheal tube will significantly impair ventilation in children when they are breathing spontaneously.

You get Julian to connect the tube to a ventilator before moving on to your circulatory assessment.