Badness BRUEing?

    NextPrevious

    Badness BRUEing?

    For the very few things they actually do, babies can be very complicated. Breathing irregularities especially can pose a challenge to providers. Knowing the difference between a benign and a dangerous cause for apnea/cyanosis/loss of muscle tone or choking is difficult and underlies the diagnosis of BRUE.

    BRUE (brief, resolved, unexplained event) usually occurs in the first 2 months of life and is defined as a combination of apnea, color change, loss of muscle tone, choking or gagging. Risk of subsequent death is 0%-6% driven in large part by those BRUE cases requiring CPR.

    Underlying causes (https://www.ncbi.nlm.nih.gov/pubmed/15499062)

    • Unknown (41%)
    • GERD/Choking/Laryngospasm (31%)
    • Seizure (11%)
    • URI/Respiratory infection (8%)
    • ENT infections (3.6%)
    • Other (5%)
    • Non-accidental trauma (1%)

    Workup: if the child appears and well in your care and symptoms are not reoccurring, how do you determine if this is a dangerous or benign event?

    • Detailed history including surrounding events, recent illness, sleeping/eating habits, family history, possible exposures and tobacco/alcohol/drugs in the house
    • Watch the child in the ED for reoccurrence
      • Remember that healthy newborns can have non-pathologic respiratory pauses up to 30s and runs of bradycardia for up to 10s during sleep (tricky babies)
      • Labs are typically not useful if the child appears well in your care

    Disposition: Traditionally BRUE cases are admitted for observation. https://www.ncbi.nlm.nih.gov/pubmed/22743742 attempted to develop a decision rule for discharging a patient home. Those who can be safely discharged are:

    • Premature with URI sx
    • Full-term with non-cyanotic color change
    • Full-term with cyanotic color change and a history of choking during the episode

    This method will drastically decrease admission rates, but misses 3.8% of patients with serious events. Thus clinical gestalt is still important when considering a child with an unexplained apnea event.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Put down that FOBT

      “The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBTRead more

    • A ‘normal’ chest Xray

      What do you see when you take a look at this Chest radiograph? It isn’t immediately noticeable (and was read as normal), and is a good reminder of why you should always check your ownRead more

    • Overshot that INR

      There have been a few cases of supra-therapeutic INR in the Sinai ED recently, and at the request of one of our superstar interns, below you will find a brief set of recommendations regarding SupratherapeuticRead more

    • Ketamine PSA with Desaturation

      During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that thisRead more

    • Sinusitis In Pediatrics?

      You’re working in pediatrics, when a mother comes in stating her 5 year old has sinusitis. He presents with fever, cough, runny nose, and some discomfort over where his frontal sinuses are. Does he haveRead more

    • Ring Removal

      Over the past week, we’ve had a strange uptick in number of patients presenting to the ER with rings stuck on their finger. This is a quick review on the options that you have regardingRead more

    • TPA For Minor Stroke?

        So, you’re working in the ED when a new stroke code is activated. You walk over and see a young gentleman with the complaint of left facial tingling, right arm and leg weakness withRead more

    • Central Line Wizardry

      I was scrolling through twitter this morning when I came across a quick video from @CriticalCareNow for an awesome central line trick. And then I went to his feed and found some more. They areRead more

    NextPrevious