Avalanche Resuscitation in the Emergency Department

Image Credit: Wikipedia

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Authors: Vivek Abraham, MS4

Medical Student
Uniformed Services University F. Edward Hebert School of Medicine

Ivan Yue, MS4
Medical Student
Uniformed Services University F. Edward Hebert School of Medicine
AAEM/RSA Publications and Social Media Committee

Alexander Li, MS4
Medical Student
Uniformed Services University F. Edward Hebert School of Medicine

Introduction
Avalanches are among the most feared events to occur in mountainous areas. Although the morbidity and mortality statistics are underreported worldwide, in North America and Europe combined there are roughly 140 avalanche-related deaths per year.[1,2] The majority of victims include snowboarders, skiers, mountaineers, and snowmobilers. With more people seeking to participate in snow sports or explore the mountains as part of expeditions, preparing to treat avalanche-related injuries is essential for an emergency physician working or traveling near a mountainous area. This article details the resuscitation guidelines that physicians can implement for those who fall victim to an avalanche as well as recommendations for mitigating avalanche exposure risk.

Bronchiolitis: Updated Guidelines

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Author: Ashley Grigsby, DO
Indiana University
Emergency Medicine/Pediatrics Residency

Originally Published: Modern Resident December 2014/January 2015

It’s that time of year again. Snow is starting to fall, holiday lights are going up and little babies are showing up wheezing in your emergency department. While babies sometimes make emergency physicians nervous, the treatment for bronchiolitis just got a little easier. The American Academy of Pediatrics recently updated their clinical practice guidelines; the last update prior to this was in 2006. These guidelines were updated to provide clinicians with the most recent evidence based management strategies.

Bronchiolitis is a viral illness caused by multiple viruses and occurs in 90% of children before the age of two. Bronchiolitis is a clinical diagnosis and as such, it does not require any testing to confirm diagnosis. Illness usually starts with rhinitis and cough, but can progress to respiratory distress.1 Exam frequently reveals tachypnea, mild retractions and expiratory wheezing.[2] Patients with more severe disease can have grunting, nasal flaring or severe retractions.[1] Assessment of these patients should include evaluation of hydration status, respiratory status, history of apnea, behavior changes and history of cyanosis.[2]

BRUE, The New ALTE

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Author: Danielle Goodrich, MD PGY-3
Stanford/Kaiser Emergency Medicine

In May, the American Academy of Pediatrics published new clinical guidelines to replace ALTE (Apparent Life-Threatening Events) with BRUE, Brief Resolved Unexplained Event. The new guidelines, in addition to defining BRUE, offer an approach to evaluation based on risk of repeat event or serious underlying disorder. The goal of the clinical guidelines is to better inform care while reducing costly and unnecessary interventions. The guidelines were devised from a comprehensive literature review of articles related to ALTEs from 1970 to 2014.

BRUE describes an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, now resolved episode with one or more of the following: (1) cyanosis or pallor, (2) absent, decreased or irregular breathing, (3) marked change in tone, and (4) altered level of responsiveness. The diagnosis is made when there is no explanation for a qualifying event after a thorough history and physical exam. BRUE and ALTE definitions differ as BRUE characterizes the event based on physician not caregiver observations and includes an age limit.