What is BRASH Syndrome?

Brash Syndrome ecg

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