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
Read MoreBackground: The management of cardiogenic shock is complex, often requiring tandem use of vasopressors and inotropes to stabilize hemodynamics. But what inotrope is more effective, dobutamine or milrinone?
Read MorePaper: Fonseca, A. L., Schuster, K. M., Maung, A. A., Kaplan, L. J., & Davis, K. A. (2013). Routine Nasogastric decompression in small bowel obstruction: Is it really necessary? The American Surgeon, 79(4), 422-428
What: Retrospective review of patients > 18 years old admitted to Yale New Haven Hospital with a diagnosis of SBO over a 5-year period. Outcomes looked at were days to SBO resolution, length of hospital stay, complications, and discharge to nursing home/rehabilitation facility between those who did and did not receive NGT decompression
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