A 30-year-old female involved in a car crash is unresponsive but breathing with a carotid pulse. You observe blood and hear gurgling sounds. What should you do first?

In this scenario, the priority is to manage the airway effectively, particularly given the presence of blood and gurgling sounds. These signs indicate that the airway is compromised, potentially due to the accumulation of blood or other fluids obstructing it. Suctioning the airway should be the first action taken, as it will help clear any obstructions and ensure that the airway remains patent, which is critical for providing adequate oxygenation.

Once the airway is cleared through suctioning, other interventions can be performed, such as inserting an oropharyngeal airway, applying a cervical collar to manage potential spinal injuries, or assisting with ventilation as necessary. However, without first clearing the airway, these subsequent actions may not be effective or could even place the patient at further risk. Therefore, addressing the immediate concern of airway obstruction through suctioning is the most appropriate initial step.