What is the focus of the physical exam in the evaluation of a brief resolved unexplained event (BRUE) (apparent life-threatening event) (ALTE)?

Updated: Feb 28, 2019
  • Author: Patrick L Carolan, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

Answer

A complete physical examination begins by obtaining a full set of vital signs, including pulse oximetry.

  • A full head-to-toe examination of the skin should be performed to look for skin lesions or signs of trauma.

  • The head and neck examination should note the characteristics of the anterior fontanelle (ie, normal, bulging, or sunken). Nondilated funduscopic examination should be performed. If retinal hemorrhages are suspected, a formal dilated indirect examination may be necessary for further characterization. [12] The nose and mouth should be examined for the presence of blood or formula.

  • The respiratory examination should include the respiratory rate, pattern of breathing, and adequacy of air exchange. The presence of stridor, wheezes, or crackles should be noted.

  • The cardiovascular examination should reveal whether murmurs are present and the adequacy and symmetry of pulses. In young infants, suspicion for ductal-dependent cardiovascular lesions may be heralded by a differential in blood pressure findings, oximetry findings, or both in the right upper extremity compared with measurements obtained from the lower extremities.

  • Abdominal distension or tenderness may indicate acute intestinal obstruction. Inguinoscrotal examination should evaluate for incarcerated inguinal hernia or testicular torsion.

  • Neurologic assessment begins with assessment of the infants’ responsiveness. Determine whether lethargy is persistent or resolved and whether the muscle tone and reflexes are appropriate for age. Also, determine if any focal or lateralizing findings are present.

  • The skin should be carefully examined for bruises. The bones should be carefully palpated for signs of trauma.


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