An unconscious 44-year-old female is cyanotic with agonal respirations. Her lips and tongue are swollen after receiving an injection of antibiotics. You are unable to ventilate. What should you do?

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When airway swelling from a severe allergic reaction leads to an inability to ventilate, the priority is to secure an airway immediately. The lips and tongue swelling indicate impending complete upper airway obstruction, and mask ventilation or intubation is unlikely to succeed in this situation. Needle cricothyrotomy provides rapid access to the trachea by bypassing the swollen upper airway, allowing ventilation right away while a more definitive airway is arranged. It’s faster and more reliable in a can't-ventilate emergency than attempting endotracheal intubation through an edematous airway, which is often unsuccessful here. Delaying to seek advanced airway assistance or simply giving oxygen without addressing the obstruction would leave the patient hypoxic. In parallel, deliver epinephrine and call for help, but securing the airway with a cricothyrotomy is the immediate life-saving step.