An unresponsive 4-year-old female is apneic but has a carotid pulse. What should you do first?

In the case of an unresponsive child who is apneic but has a carotid pulse, the foremost priority is to secure the airway. An oropharyngeal airway can help maintain an open airway and facilitate ventilation. In a pediatric patient, ensuring that the airway is clear is critical because any obstruction can lead to further complications or even cardiac arrest.

When you insert an oropharyngeal airway, it helps prevent the tongue from falling back and obstructing airflow, which is especially important in an unresponsive patient. This step also prepares the patient for further interventions, such as positive pressure ventilation if needed. After ensuring the airway is patent, additional actions, such as administering oxygen or performing chest compressions, can be considered based on the patient’s overall condition.

Prioritizing the airway in this scenario is essential, as the goal is to restore effective respiration and oxygenation, which is crucial for this child's survival.