BRUE (Pediatrics)
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 20 June 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
3 Categories: High Risk BRUE. Low Risk BRUE. Not a BRUE.
Step 1: Is This a BRUE?
* Brief* <60 seconds* Resolved* Exam and vitals back to baseline in the ED* Unexplained* No symptoms other than event itself* Event* Concerning change in any of the following…* Tone* Color* Breathing* Mental status
Step 2: Is This Low Risk BRUE?
* Five low risk criteria* Age >2 months* Born at >32 weeks gestational age* First and only episode* No CPR by medical providers* No “Red Flags”
Step 3: Do They Have Red Flags?
* For abuse* History of SIDS/BRUE in sibling* Mental illness at home* Drug use at home* For dysrhythmia* Family history of sudden unexplained death* For infection* Fevers* Unimmunized* Sick contacts* Rash
Step 4: Examine for Non-Accidental Trauma
* Bulging fontanelle* Petechia* Torn frenulum* Blood
Step 5: Place Patient Into One of Three Categories
* NOT a BRUE* Treat as you normally would* HIGH risk BRUE* Admit* LOW risk BRUE* Discharge without testing* May consider EKG and pertussis
Additional Reading
* Brief Resolved Unexplained Events (AAP)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson. Thank you so much for downloading this episode of the EM |
| 0:07.4 | Clerkship Podcast. First off, I just want to apologize for last week. I was literally opening up my |
| 0:15.9 | laptop to publish an already recorded podcast on Sunday. And my computer died. |
| 0:21.6 | It crashed. |
| 0:22.9 | And it's been over at the Apple store all week getting fixed up, |
| 0:25.8 | so I'm really sorry about that. |
| 0:27.5 | It just wasn't meant to be last week. |
| 0:29.9 | But we're going to get started again. |
| 0:31.9 | We are going to be covering a super interesting pediatrics topic today. |
| 0:37.4 | Close your eyes and imagine. |
| 0:40.1 | You pick up the chart of a pediatric patient, |
| 0:42.9 | six months old, chief complaint, loss of consciousness. |
| 0:47.6 | The triage note states that the child stopped breathing, |
| 0:51.3 | turned blue, and went limp 45 minutes ago. |
| 0:56.4 | So you go over to examine the patient, and the kid actually looks pretty good, and his |
| 1:00.9 | vitals are good. |
| 1:01.9 | And the parents, though, they are freaked out. |
| 1:04.7 | And they say, listen, I know he looks good now, doctor, but I swear he was dead. |
| 1:10.7 | We had to do CPR. Pause. What do you do? |
| 1:19.8 | Today, I'm going to give you the approach to Brewee, B-R-U-E, brief, resolved, unexplained events. This is a huge topic in pediatric emergency |
| 1:34.4 | medicine, especially. It used to be called ALTI. And the reason you probably haven't heard |
| 1:40.2 | much about it is that there was literally nothing to teach. All of these kids got admitted |
... |
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