Pediatric emergency medicine trisk 1403 1403
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Bronchoscopy
hemopericardium,
pneumopericardium
Foreign-body removal
Requires ultrasound or
ECHO guidance
Do not agitate the child
before the procedure
Esophagoscopy for
esophageal foreign body
Physical Examination
The physical examination should assess the degree and likely etiology of
respiratory distress ( Fig. 71.1A,B ). Continuous cardiopulmonary monitoring and
frequent reassessment are important because respiratory status can change
quickly. General appearance, level of consciousness, work of breathing, and vital
signs, including respiratory rate and adequacy of oxygenation and ventilation help
identify the severity of respiratory distress and possible etiologies. Heightened
level of consciousness, manifesting as restlessness, anxiety, or combativeness, is
more likely an early sign of hypoxia, whereas diminished level of consciousness,
manifesting as somnolence, lethargy, stupor, obtundation, or coma, tends to result
from hypercarbia or severe hypoxia. The child’s posture may provide clues
regarding the source of the respiratory compromise. Children with upper airway
obstruction tend to assume a sniffing position, an upright sitting posture with
neck slightly flexed and head extended. For lower airway obstruction, a tripod
position, in which the child is sitting up and leaning forward, may be preferred.
Dysphagia and/or drooling are concerning for oropharyngeal or laryngeal
obstruction. Pallor suggests possible anemia, structural heart disease, arrhythmia,
sepsis, or hemorrhage. Peripheral cyanosis is caused by local vascular changes of
the extremities that result in inadequate perfusion or vascular stasis.
