The patient with POPE often presents within minutes5,22 after the relief of an episode of upper airway obstruction characterized by vigorous inspiratory efforts without significant air movement.16,34 The initial presentation is often with dyspnea,8 tachypnea,24,39,40 agitation,8,21,34 and cough11,21,22 producing pink, frothy fluid.3,4,8,9,22,34,41 In addition to hypoxemia,7,39 the patient is also often tachycardic14,34 and hypertensive.34 Other patients have presented with frank hemoptysis,9,12,19,23,42 although this is less frequent. Residual partial obstruction may be present in this population, manifested by stridor8,11,16,21,43 or intercostal and subcostal retractions.21,24,44 On auscultation, most patients have rales,12,16,22,24,40,41 sometimes with associated rhonchi.3,14,22,25,34,40