In a patient with anaphylaxis who is unconscious, what is the top priority?

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Securing the airway is the immediate priority. In anaphylaxis, swelling of the upper airway and bronchospasm can rapidly block airflow, and an unconscious patient cannot protect or clear the airway on their own. If the airway isn’t open, you can’t effectively ventilate or oxygenate, and the risk of aspiration is high. So the first actions focus on airway protection and oxygen delivery—positioning for best airflow, suctioning secretions, and preparing for airway adjuncts or advanced airway management as needed—while you promptly treat the underlying reaction with epinephrine. Breathing and circulation are also important, but they depend on having a patent airway, and defibrillation isn’t the immediate need unless a cardiac arrest with a shockable rhythm occurs.