Krishnan SG, et al. - This prospective cohort study was undertaken to determine whether visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency department (ED). This research was carried out at paediatric ED of a tertiary paediatrics hospital in Singapore. Participants in the study were children (n= 285) managed for moderate to severe wheezing in the resuscitation bay of the ED. Study participants were evaluated for the presence of PP based on visual detection of oximeter plethysmograph before and after the bronchodilator therapy was initially inhaled. Data reported that 78 patients had PP at ED presentation. Children who had PP after initial management had significantly relative risks of needing adjunct medications, need for supplementary ventilation and admission to the high dependency unit/intensive care unit. Qualitative detection of PP on pulse oximetry can be used as a potential point-of-care tool in paediatric patients with acute moderate to severe asthma exacerbations to help assess response to initial treatment.