Osborn waves (J-waves) of hypothermia

Here is the conclusion to 68 year old female unresponsive on kitchen floor.

Let’s take another look at the 12-lead ECG.

This ECG is classic for severe hypothermia.

  • The rhythm is atrial fibrillation
  • It’s bradycardic
  • The QT/QTc is prolonged
  • Osborn waves (J-waves) are present throughout

You can see how the Osborn waves (J-waves) can be a STEMI mimic, which is one of the reasons we need clinical correlation with any ECG.

The patient was transported to the hospital where the core temperature was measured at 76F (24C).

The patient went into cardiac arrest and was defibrillated x3.

CPR was continued for the next 2 hours as the patient was re-warmed.

Remember, in this particular special resuscitation situation “you’re not dead until you’re warm and dead.”

The patient was not successfully resuscitated.

To see how Osborn waves can regress during rewarming, see Giant Osborn Waves in Hypothermia (Images in Clinical Medicine Case in the New England Journal of Medicine).

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EMS 12-Lead

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Comments
The LITFL Review 140
Masters Case #02: 60 Year Old Female – Chest Pain, Hx of Pericarditis
[…] conclusion to an extremely challenging EKG case from the EMS 12-Lead blog. For maximum learning, read part one first. […]
2014-11-24 16:26:31
Stuart
Anterior T wave inversions and PE.
Studies (can't remember them off the top of my head) have shown that TWI in V1-4 + III is 85% likely to be RV strain, 15% ischemia. If I see anterior TWI, the very next lead I look to is III
2014-11-23 18:00:51
Arlene R
The Trouble with Sinus Tachycardia
It has been very insightful for me as i read this post. Thanks to the may people who commented. Like many nurses, I was also taught to differentiate svt from st by rate and now I stand corrected. I have a Telemetry test coming up soon, I wont have the patient in front of me…
2014-11-20 19:59:33
Nick
100 yof CC: Rib pain and intermittent spasms
Can't be a potassium imbalance. The TW's wouldn't change and then change back. If it was coronary spasm, I would expect some ST segment elevation. The TW'S are also not hyperacute (peaked). Does she wear some sort of electronic stimulator?
2014-11-19 01:05:43
Anterior T wave inversions and PE. | EMS 12 Lead
Not just S1Q3T3: Look at the other 10 leads!
[…] Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: […]
2014-11-18 18:33:47

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