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

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
Very interesting discussion - I had not anticipated the degree to which giving/not giving nitro would be controversial! I had my own agenda in presenting this case, but I think it would be better to follow the interest of our readers. I'll add a few pearls about ACS, nitro, and inferior STEMIs in my discussion…
2014-08-21 00:14:19
Sassy
“Bad heartburn” – 82 y.o. female without chest pain.
Our local protocols prevent administration of GTN to RVI, Inferior STEMI with BP less than 160 systolic or HR less than 50bpm. As more than 50% of inferior MI's have RV involvement you walk a very fine line between preload and none. The HR could possibly indicate RCA occlusion so there's one side of your…
2014-08-20 22:23:14
Jonathan
“Bad heartburn” – 82 y.o. female without chest pain.
*Strongly consider withholding GTN and Morphine which could decrease venous return.
2014-08-20 21:22:02
Paul
“Bad heartburn” – 82 y.o. female without chest pain.
Screw it. I'm giving NTG/GTN. I give everybody at least 1. Not every IWMI will lose their BP from NTG. Likewise, I've even had a few RVMIs that I gave NTG/GTN to who actually improved quite a bit. Don't withhold treatment "just because." Use clinical judgement. I don't think you can do that by withholding…
2014-08-20 21:07:31
Jonathan
“Bad heartburn” – 82 y.o. female without chest pain.
ST elevation II, III, aVF Inferior Infarct requires repeat ECG with V4R to check for right ventricular infarct. If this is the case then a fluid bolus may be indicated to increase venous return to the left ventricle. RCA occlusion is the most likely cause. Right ventricular infarcts can present with symptomatic bradycardia. Aspirin, GTN…
2014-08-20 20:52:27

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