BRASH

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Ian L., Dr -

How common is this syndrome ?
It could also occur. I chronic heart failure on ACE b blocker and Spironolactone ?

joshua f. -

There's no robust data on how common the syndrome is. I think BRASH is reasonably common, something I see perhaps 3-6 times per year in the ICU.

kelcie d. -

is treating the bradycardia with atropine something that would be helpful or not?

joshua f. -

I think epi is the way to go here for a few reasons:
1) Epinephrine will improve the potassium (atropine won't).
2) Epinephrine can be given as a continuous infusion for several hours until the patient improves (whereas atropine may work for a short period of time, but then the patient will slip back into bradycardia)
3) Epinephrine is just more powerful (there are some patients who won't respond to atropine, but who may respond to epinephrine). For the sickest, peri-arrest BRASH patients, epinephrine will get you more traction.

There's nothing wrong per se with atropine, but I just think overall epinephrine is a superior agent here. If the patient is mildly ill and they respond to atropine that's fine too.

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