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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Comments
michelle
68 Year Old Male: Chest Tightness – Part 1
i see some depression and slight elevation in the st segment in the avr. i would alert the stemi crew to stand by.
2015-07-27 17:15:03
sean morrison
68 Year Old Male: Chest Tightness – Part 1
It's the big one Weezy! LAD
2015-07-27 12:48:03
Brooks Walsh MD
Computer misses it, but the medic catches it.
Well this blog is a great place to start! We cover most every aspect of emergency electrocardiography, with a variety of authors, and multiple perspectives, usually in a clinical context. If it is a book you are looking for, I prefer Ken Grauer's. I started with Dr Grauer as a paramedic student and I still…
2015-07-27 01:45:18
michelle
63 Year Old Female, CC: Neck and Arm Pain
looks like stemi . o2 , fluids, monitor and transport to nearest facility.
2015-07-26 16:24:04
The Six-Step Method for 12-Lead ECG Interpretation | EMS 12 Lead
Axis Determination – Part I
[…] 2.) Axis determination […]
2015-07-26 13:08:05

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