A 4-year-old has ingested four tablets of Elavil. What is the first intervention you would perform?

In the case of a 4-year-old who has ingested four tablets of Elavil, the correct initial intervention prioritizes the patient's airway and breathing. Administering supplemental oxygen via Bag-Valve-Mask (BVM) addresses potential respiratory depression or compromise, which is a common risk associated with an overdose of antidepressants like Elavil (amitriptyline). This medication can lead to central nervous system effects, possibly resulting in decreased respiratory function.

Ensuring that the child is adequately oxygenated is crucial in any overdose situation. By providing supplemental oxygen early, you help to maintain vital organ function and prevent further complications associated with hypoxia.

Other interventions like administering activated charcoal, providing fluids, or starting an IV line may be necessary after ensuring that airway and breathing are stable, but they do not directly address the immediate life-threatening concerns in the same way that managing the airway and making sure the patient is receiving adequate oxygen does.