This case-based trauma lecture explores the management of a critically injured pediatric patient with penetrating trauma. Through a real-world scenario, participants will analyze prehospital and early hospital decision-making, focusing on rapid assessment, hemorrhage control, and indications for high-risk interventions. The discussion highlights the role of resuscitative thoracotomy in pediatric patients, including current evidence, survival considerations, and operational challenges. Additionally, the lecture examines the integration of low-titer O positive whole blood in trauma resuscitation, emphasizing its application in pediatric care, logistical considerations, and emerging best practices. This session is designed to challenge clinical decision-making and reinforce evidence-based trauma care for advanced EMS providers and critical care teams.