What is BRASH Syndrome?

BRASH Syndrome

B - Bradycardia

R - Renal failure

A - AV nodal blockade

S - Shock

H - Hyperkalemia

Typical ECG in BRASH: HR 30, peaked T waves, flattening of P waves (Bradycardia out of proportion to other findings of hyperkalemia)

BRASH Treatment:

• Aggressive treatment of hyperkalemia

• Consider epinephrine (↑HR and drives K+ intracellularly)

• If hypovolemic, give IV fluids ("balanced fluids" > normal saline)

• If on a Ca2+ channel blocker, ß blocker, or digoxin, consider reversal strategy

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