A 3–year-old boy is brought to the casualty by his mother with progressive shortness of breath for 1 day. The child has a history of bronchial asthma. On examination, the child is blue, gasping and unresponsive What will you like to do first –

**Core Concept**
The scenario describes a child in severe respiratory distress, likely experiencing status asthmaticus, a life-threatening condition requiring immediate attention. The child's cyanosis, gasping, and unresponsiveness indicate severe hypoxia and impending respiratory failure.

**Why the Correct Answer is Right**
In this situation, the primary goal is to establish a secure airway and ensure adequate oxygenation. The first step would be to administer 100% oxygen via a non-rebreathing mask, followed by bag-valve-mask (BVM) ventilation if necessary. This is crucial to prevent further hypoxia and potential brain damage.

**Why Each Wrong Option is Incorrect**
**Option A:** Administering bronchodilators would be premature without first securing the airway and ensuring adequate oxygenation.
**Option B:** Intubation is a crucial step, but it is not the first step in this scenario. Establishing a secure airway requires careful preparation and oxygenation first.
**Option C:** Intraosseous access may be necessary for medication administration, but it is not the immediate priority in this situation.

**Clinical Pearl / High-Yield Fact**
In pediatric emergencies, always prioritize securing the airway and ensuring adequate oxygenation before administering medications or performing other interventions.

**Correct Answer:** B. Intubate the child after administering 100% oxygen via a non-rebreathing mask.

✓ Correct Answer: B. Administer 100 % oxygen by mask