Brief Resolved Unexplained Events Flashcards
Clinical presentation of a BRUE/Defintion
BRUE definition: brief (sudden <1 minute), resolved (patient returns to reassuraing baseline after the event, including vitals, unexplained (no choking, abuse, metabolic issue), event: episode of >1 of the following:
→ cyanosis or pallor, absent, decreased or irregular breathing, marked change in tone (hyper or hypotonia), altered level of responsiveness
Risk Stratification of BRUE
Protective Factors
- Age >60 days
- Born >32 weeks gestation and corrected gestational age >45 weeks
- No CPR by trained medical provide
- event lasted<1 minute
- First event.
The main risk factors for BRUE are:
A prior episode when the child stopped breathing, turned pale, or had blue coloring
Feeding problems
Recent head cold or bronchitis
Age younger than 10 weeks
Low birth weight, being born early, or secondhand smoke exposure also may be risk factors.
List the initial investigations for a pediatric patient WHO IS HIGH RISK who presents with a BRUE
Two tier approach:
Initial evaluation: perform in initial eval in emergency setting. Monitor with continuous pulse oximetry monitoring for at least 4 hours. Social worker consultation for child abuse. Feeding evaluation with a feeding therapist. Consider ECG and pertussis, rapid fire respiratory panel, COVID, hematocrit and limited metabolic work up (glucose, lactic acid, bicarb, vanous blood gas), MRI and skeletal survey
2nd Evaluation: Admit to the hospital for continuous prolonged oximetry, observation for repeat events, clinical swallow evaluation and feeding consultation.
2 outcomes after this step: you either identify a diagnosis that explains the event → manage accordingly. OR: you have no explanation within 24 hours, then: discharge home, CPR teaching, provide detailed information to the primary care clinician and arange close follow-up
Outline initial management for a pediatric patient WITH LOW RISK FACTORS who presents with a BRUE
Should: educated about BRUE, offer resources for CPR training to caregivers.
May: consider pertussis testing and 12 lead ECG. Briefly monitor patients with continuous pulse oximetry and serial observations.
DO NOT initiate home monitoring, do not do an extensive workup. Need not obtain viral respiratory tests, and do not admit the patient solely for cardioresp monitoring.
