You encounter an unresponsive patient with snoring respirations. You attempt neutral alignment but feel resistance and hear neck crepitus. What should you do first?

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In trauma patients with suspected cervical spine injury, protecting the spine comes first and the airway must be opened without moving the neck. The snoring respirations point to obstruction from the tongue and soft tissues, so you want to clear that while keeping the spine immobilized. Continuing to move or extending the neck would risk worsening a possible fracture, especially with neck crepitus signaling injury. The jaw-thrust maneuver advances the mandible forward, lifting the tongue away from the back of the throat and opening the airway without extending the neck, making it the best first action. Once the airway is opened, assess breathing, suction as needed, provide oxygen, and consider definitive airway management if ventilation remains inadequate.