Critical Care Time 56. Tales from the ICU: BRASH Syndrome
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Aug 25, 2025 Join the hosts as they delve into a gripping clinical mystery from the ICU! They analyze a case involving a 79-year-old woman with puzzling symptoms, emphasizing the importance of collaboration between emergency and critical care physicians. The discussion highlights the complexities of diagnosing BRASH syndrome and dives into its pathophysiology. Listeners will uncover the nuances of managing bradycardia and hyperkalemia in critically ill patients, all while learning through a captivating and interactive storytelling approach!
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Start Broad, Then Narrow With Data
- Build a broad differential across organ systems and toxicologic causes.
- Check telemetry, EKG, troponin, TSH, cortisol, meds, and renal function early.
Use EKG To Localize The Problem
- Obtain a 12‑lead EKG and interpret rhythm to localize the problem.
- Identify junctional escape rhythms to suspect SA node failure or AV nodal issues.
Synergy Explains Disproportionate Bradycardia
- Modest hyperkalemia or AKI may not fully explain severe bradycardia alone.
- Look for synergistic causes like drug accumulation to explain disproportionate bradycardia.