Pediatric emergency medicine trisk 1386 1386
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cause of accidental death in toddlers. A history of abrupt onset of choking or
gagging is suggestive. Drooling, dysphagia, and stridor suggest an upper airway
foreign body, whereas unilateral wheeze, particularly first-time wheeze with acute
onset, suggests lower airway position. Presentation, particularly with lower
airway foreign body, may be delayed by days to weeks from time of aspiration.
TABLE 71.1
Criteria for Respiratory Failure a
Clinical
Laboratory
Tachypnea, bradypnea, PaO2 <60 mm Hg in 60% O2 b
apnea, irregular
respirations
Pulsus paradoxus >30 Paco2 >60 mm Hg and rising
mm Hg
Decreased or absent
pH <7.3
breath sounds
Stridor, wheeze,
grunting
Severe retractions and
use of accessory
muscles
Cyanosis in 40% O2 b
Depressed or
heightened level of
consciousness,
decreased response
to pain
Weak to absent cough
or gag reflex
Poor muscle tone
a Respiratory
b Excluding
failure is likely if two clinical findings and one laboratory finding exist.
cyanotic heart disease.
