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