those available over the counter, and poisons available in the household may be important in treating an older child Finally, obtaining a detailed social history may provide information that is pertinent to the care of the child Is There an Underlying Cause? A careful physical examination identifies many treatable acute illnesses that can cause apnea One clue to serious systemic disease is abnormal body temperature, including fever or hypothermia Tachypnea may suggest either a respiratory or a metabolic problem Signs of shock should prompt consideration of potential underlying etiology, including sepsis or hypovolemia from occult trauma Evaluation of the nervous system should include notation of mental status, palpation of the fontanelles, and funduscopic examination Dysmorphic features might suggest an underlying congenital abnormality Bruising may be indicative of nonaccidental trauma However, an entirely normal physical examination provides no reassurance that the described event was clinically insignificant and will not recur For the child with a diagnosis of BRUE and considered to be lower risk ( Table 14.2 ), it is recommended that minimal testing be done Engaging caregivers and utilizing a family-centered approach can help guide management, disposition, and follow-up Resources such as cardiopulmonary resuscitation (CPR) training classes can be provided Further testing should be guided by the history and physical examination A 12-lead EKG looking for dysrhythmias may be ordered Laboratory testing is not routinely performed, but may be indicated for specific clinical concerns Pertussis testing might be considered when there is an appropriate history or possible exposure For other potential diagnoses, tests to consider in the ED include a measurement of blood glucose and serum electrolytes Any indication that the infant could have a serious infection should be pursued with cultures of blood, urine, and cerebrospinal fluid Urine and blood for toxicologic analysis should be obtained from patients who may have been exposed to toxic substances or medications Noninvasive pulse oximetry is adequate to identify hypoxemia, and significant metabolic acidosis will be identified through analysis of serum electrolytes The arterial or venous blood gas examination does not serve as a screening test for a serious event and should only be obtained on the basis of specific indications Radiologic studies (such as of the lateral neck, chest, abdomen, or neuroimaging) should be performed as indicated by the history and physical examination The tasks of the emergency physician faced with a young patient who has had an apneic episode are to identify whether he or she should be hospitalized and to treat underlying conditions If a careful history and physical examination suggest