A 6-month-old female is unresponsive, has retractions, and a rate of 38. What should you do first?

In this scenario, the 6-month-old female is unresponsive and demonstrating retractions, which indicates respiratory distress. The critical first step in managing this situation is to assist her ventilation. In an unresponsive infant, the likelihood of insufficient or ineffective breathing is high, and immediate intervention is crucial to ensure that adequate oxygen is delivered to the lungs and subsequently to the vital organs.

Assisting ventilation helps to manually ensure that she receives sufficient air movement to support her body's needs. This may involve using a bag-valve-mask (BVM) technique, where a resuscitation bag is used to provide breaths. Before any other action, such as assessing vital signs or administering oxygen, the priority is to address the immediate threat to her airway and ventilation.

Overall, managing respiratory distress effectively through appropriate ventilation support is vital in stabilizing the patient while further assessments and treatments can be conducted.