The Heart of the Matter - A Case of Abnormal Telemetry

June 15, 2025

A 79-year-old female with hypertension, CKD Stage 4, history of breast cancer s/p tamoxifen therapy, osteoporosis presenting to the emergency department for pleuritic chest pain radiating to back. Laboratory work-up is significant for a troponin of 0.24, a d-dimer of 2.40., and a creatinine of 2.4 (baseline 1.8). The plan is for the patient to be admitted to medicine for V/Q scan to evaluate for pulmonary embolism. The patient’s EKG (Figure 1) is shown below.

Michael Hohl, MD and Ari Edelheit, MD

**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 Heart Of The Matter - A Case of Left-Sided Chest Pain

March 21, 2025

A 60-year-old male with a past medical history of hypertension, coronary artery disease status post stenting of the left anterior descending (LAD) artery and right coronary artery (RCA) in 2023 presents to the emergency department (ED) with a chief complaint of left-sided chest pain that started one hour prior to arrival.

Michael Hohl, MD; Taylor Wahrenbrock, MD; Ari Edelheit, MD

the County Consult