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Home > Emergency Medical Minute > Episode 991: BRASH
Podcast: Emergency Medical Minute
Episode:

Episode 991: BRASH
Category: Science & Medicine
Duration: 00:02:17
Publish Date: 2026-01-19 10:00:00
Description:

Contributor: Aaron Lessen, MD

Educational Pearls

BRASH Syndrome:

  • Bradycardia

  • Renal Failure

  • AV Nodal Blockade

  • Shock

  • Hyperkalemia

Clinical Features:

  • Profound bradycardia and shock in patients on AV nodal blockers:

    • Commonly, Beta Blockers or Calcium Channel Blockers

Etiology:

  • Caused by an inciting kidney injury:

    • Common triggers include precipitating illness, dehydration, or medications

    • Results in hyperkalemia

  • The enhanced effect of the combination of AV nodal blockade and hyperkalemia leads to a more profound presentation of shock.

Treatment:

  • IV Fluids, unless volume overloaded

  • Epinephrine for bradycardia

  • Lasix for volume overload, only if the patient is still making urine

  • Low threshold to dialyze for hyperkalemia

  • Focus on treating early and more aggressively.

References:

Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167.

Summarized by Ashley Lyons OMS3

Editting by Ashley Lyons OMS3 and Jeffrey Olson MS4

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