Pediatric Brief Resolved Unexplained Event (BRUE)  

Patient Care Goals

  • Recognize patient characteristics and symptoms consistent with a BRUE 
  • Promptly identify and intervene for patients who require escalation of care
  • Identify high risk patients and choose proper destination for patient transport

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Thorough physical exam and history are critical to exclude other causes
□ Maintain a high level of suspicion for non-accidental trauma

High Risk if:
• <60 days old
• <32 weeks gestation
• >1 minute (currently or historical)
• >1 event
• Concerning history or exam
• CPR provided		□ Child < 1yo
□ Well appearing child
□ Hx of any of the following: 
□ Cyanosis or pallor
□ Absent, decreased, or irregular breathing
□ Marked change in tone (hyper- or hypotonia)
□ Altered level of responsiveness.
□ No alternative cause		□ Upper or lower respiratory tract infection
□ Trauma/Abuse
□ Toxic Ingestion
□ Sepsis
□ Metabolic disorder
□ GERD (spitting up)
□ Seizures
□ Cardiac disease/arrhythmia
□ Infantile botulism
□ Hypoglycemia

Clinical Management Options

EMT-B
• Place in position of comfort
• Obtain complete set of vitals
• POC blood glucose
• Oxygen target SpO2 92% – 96%  
• ETC02 if patient will tolerate
• Cardiac monitor and continuous pulse oximetry 
• Thorough physical exam of the exposed child
Paramedic
• Consider EKG if concern for cardiac etiology or cardiac history 
• IV access not indicated unless signs of shock or dehydration
Signs of Respiratory Failure-Separate checklist under pearls please
• History of circumstances and symptoms before, during, and after the event, including duration, interventions done, and patient color, tone, breathing, feeding, position, location, activity, level of consciousness, bystander CPR or rescue breaths 
• Other concurrent symptoms (fever, congestion, cough, rhinorrhea, vomiting, diarrhea, rash, labored breathing, fussy, less active, poor sleep, poor feeding) 
• Prior history of BRUE 
• Past medical history (prematurity, prenatal/birth complications, gastric reflux, congenital heart disease, developmental delay, airway abnormalities, breathing problems, prior hospitalizations, surgeries, or injuries) 
• Family history of sudden unexplained death or cardiac arrhythmia in other children or young adults 
• Social history: who lives at home, recent household stressors, exposure to toxins/drugs, sick contacts) 
• Considerations for possible child abuse (multiple/changing versions of the story; reported mechanism of injury does not seem plausible, especially for child’s developmental stage) 
Consult Online Medical Control as Needed

Pearls

  • Regardless of patient appearance, all patients with a history of signs or symptoms of BRUE should be transported for further evaluation 
  • Consider transport to a facility with pediatric critical care capability for patients with high risk criteria as above
  • Contact direct medical oversight if parent/guardian is refusing medical care and/or transport, especially if any high-risk criteria are present