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 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).