foreign matter In the alert patient with suspected soft tissue obstruction of the airway, a nasopharyngeal airway may improve airway patency In an unconscious patient, an oropharyngeal airway can be placed to relieve obstruction Bag-valvemask ventilation should be initiated in apneic patients or those with ineffective respiratory efforts The child in whom airway patency and/or adequate ventilation and oxygenation cannot be established or maintained using noninvasive approaches, requires endotracheal intubation Indications for endotracheal intubation directly related to respiratory distress include airway obstruction, inability to handle secretions, and risk of aspiration, and respiratory failure Tension pneumo- or hemothorax and/or pericardial fluid causing tamponade must be decompressed immediately Ultrasound is increasingly being used in management of patients in respiratory distress, including to establish lung pathology, to confirm tracheal intubation, and to guide relevant procedures (e.g., thoracentesis, thoracostomy, pericardiocentesis) Adjunctive therapies that can help with respiratory distress include placement of a nasogastric tube to decompress a distended abdomen and full expansion of the lungs, addressing fever, and correcting metabolic derangements and/or drug or toxin intoxication