BRASH is defined as a combination of bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia. Furthermore, “the BRASH acronym is used to describe a syndrome where the synergistic effects of AV nodal blockers and renal impairment lead to severe bradycardia and hyperkalemia” (NCBI, 2023). BRASH is due to a positive feedback loop. Synergism between AV blockers and hyperkalemia cause a drop in heart rate which drops our cardiac output and thus our BP. This causes hypoperfusion to our kidneys thus causing renal injury/failure. This decreases the Glomerular Filtration Rate (GFR) which in turn decreases the amount of AV blockers to be excreted and potassium to be excreted. Build up of beta blockers cause the cells to secrete more K+ which increases serum potassium. Build up of potassium once again combined with the AV blocker meds and the cycle repeats. It should be mentioned that ACEi/ARBs decrease aldosterone concentrations which decreases the amount of potassium being excreted. Aldosterone causes reabsorption of sodium (and the water follows) and potassium should be excreted. Low levels prevent potassium from being excreted so they build up. BRASH syndrome is typically found in the elderly patient that is taking cardiovascular medications and suffering from dehydration. It is important to note that the typical ECG findings associated with isolated hyperkalemia (e.g peaked T waves, wide QRS) may be absent. Additionally, the bradycardia seen may be out of proportion to the other ECG findings typically found with hyperkalemia. Key components of therapy include volume management, treatment of bradycardia, treatment of hyperkalemia, and treatment of any underlying cause(s). **Disclaimer: this is a reference. Please use your own protocols* 📚Sources: https://lnkd.in/g94p6AvF. https://lnkd.in/g_xXzi7N. https://lnkd.in/guvT49_5 #FOAMed #nurse #paramedic #ems #medical #meded #medicaleducation #criticalcare #emergencymedicine #physician