What should be your immediate action when arriving on the scene of an unresponsive child with Down syndrome and gurgling respirations?

When arriving on the scene of an unresponsive child with gurgling respirations, the best immediate action is to open the airway using a manual maneuver and suction as necessary. In this situation, the child is unresponsive, indicating potential airway obstruction, which is often exacerbated by secretions in the airway.

Gurgling respirations suggest that there may be fluid or mucus present, compromising the child's ability to breathe properly. By utilizing a manual maneuver to open the airway — typically a head tilt-chin lift or jaw thrust — you can improve airflow. Suctioning would then help clear the airway of any secretions, which is critical for ensuring the child can breathe effectively.

Administering oxygen without addressing airway patency would not be beneficial, as oxygen cannot reach the lungs effectively if the airway is obstructed. Starting chest compressions is not appropriate at this stage unless there is a lack of pulse and respiratory effort after determining the airway is clear. Waiting for backup would delay necessary interventions, which could be critical for the child's survival. Thus, taking immediate action to ensure the airway is open and clear is the essential first step in this emergency scenario.