Respiratory failure is one of the scariest presentations in the clinic, ED, and hospital. How do you generate a differential and plan for the child who cannot breath? Pulmonologists Dr. Powell and Dr. Wyatt describe how we can use our physical exam and an anatomic approach as a framework for diagnosis and initial management of respiratory failure in children. Next time you find yourself staring at the pulse ox reading 85% and hoping for it to change, take a peek at this schema.