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I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

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Sunday, 14 July 2019

BRUE

A BRUE or an ALTE needs thorough history taking and examination.

It is defined as:

“an episode that is frightening to the observer and that is
characterized by some combination of apnea (central or obstructive), color
change (usually cyanotic or pallid, but occasionally erythematous or plethoric)
marked change in muscle tone (usually marked limpness), choking"

ie Apnoea, Looks Different, Tone different, Exhibits unconsciousness

If this occurs whilst the child is sleeping, it may be apnoea of infancy. The child may also have insomina, hypersomnia etc. History will be key!


Take a careful history. And if there are no high risk features, the child can probably go home.
References
https://pedemmorsels.com/brue/
http://dontforgetthebubbles.com/brue-is-the-new-black/ 
http://www.stemlynsblog.org/alte-brue/
http://foamcast.org/2016/05/04/episode-49-the-aap-brue-guidelines/
https://www.ncbi.nlm.nih.gov/pubmed/15499062
https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/central-sleep-apnoea-syndrome-csa
http://sleepeducation.org/sleep-disorders-by-category/sleep-breathing-disorders/infant-sleep-apnea/overview-facts
https://www.rcemlearning.co.uk/foamed/pem-and-ex-prems/
https://www.rcemlearning.co.uk/reference/myocarditis/
https://www.rcemlearning.co.uk/modules/causes-and-management-of-myocarditis/

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