**Figure 1.** BRASH Syndrome feedback loop (Source: https://litfl.com/brash-syndrome/)

The Cheese - BRASH Syndrome

June 6, 2025

It’s 3 a.m. on an overnight shift and the resuscitation room nurse runs over, “Hey doc, the patient in R3 is bradycardic and now his blood pressure is dropping”. You rush in, begin thinking through which medications to give and place pads on the patient. Luckily, he begins to stabilize with vasopressors and pacing. You review his labs again; he has worsening renal function and he’s mildly hyperkalemic to 5.7. He has metoprolol on his medication list but denies taking more than prescribed. So what’s actually going on?

Today we will discuss BRASH syndrome, which stands for Bradycardia, Renal failure, AV Blockade, Shock and Hyperkalemia.

Kathryn McGregor, MD and Eric Leser, MD

The Cheese - Managing the Physiologically Difficult Airway

February 28, 2025

Managing the physiologically difficult airway is one of the highest acuity and highest stress challenges in the Emergency Department (ED) setting. Here, we will discuss pre-oxygenation with non-invasive ventilation.

Kathryn McGregor, MD; Taylor Wahrenbrock, MD; Eric Leser, MD

**Figure 1.** Index point-of-care echocardiogram.

A Case of Cardiac Tamponade Secondary to Malignant Effusion

October 11, 2024

A 40-year-old man with no known past medical history presented with one week of fatigue and dyspnea on exertion. In the last week, the patient developed significant shortness of breath with only a few steps. The patient reported an unintended weight loss of 25 lbs in the last two months, as well as one month of intermittent epigastric abdominal pain and associated nausea. In the last week, the patient was seen by an outside clinic and diagnosed with H. pylori and started on treatment for H. pylori. He denies any other acute complaints or symptoms including orthopnea or paroxysmal nocturnal dyspnea.

Alejandro Ruiz, MD

the County Consult