Which of the following patients requires suctioning?

The situation involving the 23-year-old patient who is unconscious in a supine position from alcohol intoxication and has vomited indicates a clear need for suctioning. When a patient is unconscious and has compromised airway reflexes, they are at significant risk for aspiration. The presence of vomit greatly increases this risk, as it can obstruct the airway and lead to aspiration pneumonia or severe respiratory distress. Suctioning in this case is crucial to clear the airway of any vomit, which would prevent airway obstruction and facilitate proper ventilation.

The other scenarios present conditions where suctioning is generally not indicated. The patient with CHF who is sitting upright and has crackles typically indicates fluid in the lungs, necessitating different management strategies like oxygen therapy or diuretics rather than suctioning. The 4-year-old patient who is leaning forward and drooling may suggest a foreign body obstruction or severe respiratory distress, but suctioning is not the immediate intervention without knowing the status of the airway. The patient with pneumonia is expelling discolored phlegm on their own, which suggests they have some level of airway patency and are managing their secretions; suctioning would not be warranted unless there was evidence of obstruction or inability to clear the secretions themselves.