Episode 113 – Being B.R.A.S.H. When Treating Bradycardia w/Dr. Kate Connelly and Jake Miller


B.R.A.S.H. Syndrome is a phenomenon with a constellation of Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia requiring identification and management in the prehospital and transport setting. In this podcast episode, live from AMTC23, we discuss the pathophysiology of BRASH Syndrome, highlighting the synergy between its components, as well as relevant pharmacotherapy and treatment considerations.




Katherine Connelly, MD NRP, FP-C

Dr. Connelly is an EMS fellow at the University of Cincinnati and a flight physician for UC Health Air Care & Mobile Care. She completed residency training in Emergency Medicine at the University of Cincinnati, medical school at the University of North Carolina, and earned her undergraduate degree in physics from Amherst College. Prior to medical school, she worked as a full-time paramedic, taught English in Japan, and fought wildfires on a Forest Service Hotshot crew. She currently serves on the Air Medical Physician Association Board of Trustees.


Jacob Miller, DNP, MBA, NP, CNS, NRP

Jacob Miller is a Nurse Practitioner, Clinical Nurse Specialist, and Paramedic with a background in flight, critical care transport, and emergency care. After over a decade of direct patient care in HEMS/CCT, he has recently transitioned into the department educator role at UC Health Air Care & Mobile Care in Cincinnati, OH. In addition to his clinical practice, Jacob is on the Board of Directors of the Air & Surface Transport Nurses Association, is chair of the Emergency Nurses Association’s advanced practice advisory council, and co-chairs the EMS Special Interest Group with the American Academy of Emergency Nurse Practitioners.

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Grigorov MV, Belur AD, Otero D, et al. The BRASH syndrome, a synergistic arrhythmia phenomenon. Proc (Bayl Univ Med Cent). 2020;33:668-70

Ravioli S, Woitok BK, Lindner G. BRASH Syndrome – fact or fiction? A first analysis of the prevalence and relevance of a newly described syndrome. Eur J Emerg Med. 2021;28(2):153–155. doi:10.1097/MEJ.0000000000000762

Schnaubelt S, Roeggla M, Spiel AO, et al. The BRASH syndrome: an interaction of bradycardia, renal failure, AV block, shock and hyperkalemia. Intern Emerg Med. 2021;16(2):509–511. doi:10.1007/s11739-020-02452-7

Shah P, Gozun M, Keitoku K, et al. Clinical characteristics of BRASH syndrome: Systematic scoping review. Eur J Intern Med. 2022;103:57–61. doi:10.1016/j.ejim.2022.06.002

Farkas J. PulmCrit- BRASH syndrome: Bradycardia, Renal failure, Av blocker, Shock, Hyperkalemia. 2016 Feb 15; https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/

Farkas J. BRASH Syndrome. Internet Book of Critical Care. 2020 Sept 28. Updated 2021 Jun 26; https://emcrit.org/ibcc/BRASH/

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