Brief Resolved Unexplained Event Clinical Pathway — History and Physical Examination — Emergency

Brief Resolved Unexplained Event Clinical Pathway — Emergency and Inpatient

History and Physical Exam

A careful history and physical exam characterizes the event, identifies possible underlying causes and assesses the risk of recurrence. Routine testing is usually not needed.

History

Event Characteristics
  • Preceding illness or injury
  • Event Description
    • Location, position, feeding, environment, timing of the event
    • Choking, gagging
    • Tone, movement
    • Mental status
    • Level of distress
    • Color change - pallor, red, blue
    • Breathing ability - apnea, shallow breathing, or difficulty breathing
    • Duration, interventions, return to baseline
Pertinent Past
  • Prematurity (gestational age < 32 wks)
  • Previous episode, BRUE diagnosis
  • Newborn screening results
  • Growth and development
  • Breathing problems
  • Reflux
  • Medications
Family
  • Sudden unexplained death
  • Cardiac disease, arrhythmias
  • Metabolic/genetic disease
Social

Physical Exam

Vital Signs Temp, HR, RR, BP, oxygen saturation
Growth Weight, head circumference
General Appearance Craniofacial abnormalities, age-appropriate responsiveness
Head/Neck Shape, fontanels, evidence of injury, neck mobility
Eyes Pupillary response, conjunctival hemorrhage
Otolaryngology TMs, congestion/coryza, blood presence, torn frenulum or evidence of other trauma
Cardiorespiratory Increased work of breathing, abnormal breath sounds
Abnormal rhythm, rate, auscultation findings
Gastrointestinal/
Genitourinary		 Organomegaly, masses, distension, tenderness, GU abnormalities
Extremities Muscle tone, deformity
Neurologic Alertness, tone, reflexes, movement and strength symmetry
Skin Color, perfusion, bruising, erythema