Pediatric emergency medicine trisk 1407 1407
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obscure focal findings, and upper airway sounds are often transmitted to lower
airways. The ratio of inspiratory to expiratory phase of respiration, normally 1:1,
can be useful in distinguishing an upper from lower respiratory tract obstructive
causes of respiratory distress. Respiratory distress from upper airway disease
usually results from difficulty of inward air movement. The inspiratory phase is
often increased relative to the expiratory phase. Lower airway processes often
impede outward air movement and may result in a prolonged expiratory phase.
Absence of wheeze in a child with continued or worsening respiratory distress
may represent severe obstruction and should not be considered reassuring but
rather may herald impending respiratory arrest.
