There is almost certainly some degree of pulmonary contusion here given the external bruising and inability to get the oxygen saturations above 95%. With soft, pliable ribs there are often no rib fractures with significant underlying organ injury.

Of course the child may have aspirated as well, given he has been unconscious for some time with an unprotected airway. 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.