Assistant Professor University of Maryland Baltimore, Maryland
Disclosure(s): No financial relationships to disclose
Disclosure(s):
Rohit Menon, MD: No financial relationships to disclose
BRASH syndrome, a spiraling crash state involving bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia is often underrecognized and undertaught. Despite its high morbidity, BRASH often masquerades as isolated hyperkalemia or AV nodal blocker toxicity, leading to misdirected interventions such as ineffective pacing or standard ACLS protocols that fail to address the underlying pathophysiology.
This session will guide participants through the recognition, diagnosis, and resuscitative management of BRASH syndrome. Special focus will be placed on how to recognize BRASH in the absence of severe hyperkalemia or overt overdose, and how to break the self-perpetuating cycle using targeted interventions including potassium modulation, addressing underlying causes and providing hemodynamic support.
Learning Objectives:
Define BRASH syndrome and describe the underlying pathophysiologic interplay between bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia.
Differentiate BRASH syndrome from isolated hyperkalemia and AV nodal blocker toxicity, emphasizing diagnostic features and clinical clues.
Identify strategies to interrupt the cycle of BRASH syndrome through targeted resuscitative interventions and pharmacologic management.
