Conclusion to 68 yof CC: Unresponsive on kitchen floor – Osborn 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

osborne_waves

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 76°F (24°C).

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

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
iliyas
Masters Case #01: 50 Year Old Male – Severe Chest Pain
Short runs of V.T LAD LAHB Widespread st depression with St elevation in avr Lf msin / three vessle disease Not sure about rhythm
2015-08-26 06:34:44
Darren Earley
Masters Case #01: 50 Year Old Male – Severe Chest Pain
1. L.A.D 2. De Winters (ST Elevation aVR, ST abnormality V2-3). 3. Non sustained VT 4.Poor quality ECG so cannot say about p waves or whether A.fib. Pre alert for ppci = evolving occlusion of LAD artery. Aspirin. Pain relief. Diesel
2015-08-25 17:26:50
michelle
Masters Case #01: 50 Year Old Male – Severe Chest Pain
first pt. sat's are to low at 94% for just room air pt. needs hi-flow o2 at 15 lt. min. i see a-fib. with runs of 3. st depression. there is also a chance of pheumonia. after o2 administer fluids, a chest x-ray, monitor the heart and ekg especially where bp is low.
2015-08-25 16:57:39
Ivan Rios
Understanding Adenosine (Adenocard)
Correct, even for stress test, with the same purpose.
2015-08-18 17:07:24
Joppe
Understanding Adenosine (Adenocard)
Adenosine is also used to measure FFR in the cathlab to achieve maximum vasodilation in the vessels in the Heart.
2015-08-18 16:02:13

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