Just curious.

5-year-old, 10 days post-tonsillectomy, came to ER with a significant post-op hemorrhage. Bleeding was ongoing and not controlled with TXA. The child was actively vomiting blood with a stomach ache. They received two units of PRBCs due to blood loss.

The patient needed to be transferred about 40 minutes away for emergency cauterization. With that amount of active bleeding and continuous hematemesis, would you choose to intubate for airway protection prior to transport, or manage without intubation during the transfer?