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
Richard Kenkel
64 y.o. Female with CP – “And then I gave her a NTG…”
Cardiac arrest? Its a RELATIVE contraindication. You need to use clinical gestalt. Her blood pressure is quite high, and her heart rate is average, she would probably tolerate nitro quite well. Provided she's not on beta blockers or calcium channel blocker, orthostatic hypotension etc, from what I can tell she'd compensate just fine. While there…
2014-09-16 02:05:12
Stephen Smith, of Dr. Smith's ECG Blog
59 year old male: chest pressure
Inferolateral MI, not RV (T-wave down in V1)
2014-09-14 18:16:53
Alex
The 360 Degree Heart – Part I
Some models of ECG machines have an option to flip aVR upside down. In this case it looks at +30* and fills in the gap between I and II.
2014-09-14 16:00:21
Lucas
59 year old male: chest pressure
Besides MI and Aortic Dissection, this presentation of acute chest pain and hemodynamic compromise, associated with important dyspnea would concern me for PE, which I think should be properly investigated.
2014-09-14 14:35:36
Joseph Goodson
The 360 Degree Heart – Part I
As a new Paramedic, this information is very useful and helpful. I believe there is more to understanding paramedicine than what can be taught in a class and it takes the initiative of the medic to pursue. Thank you for providing this simple yet understandable concept. Honestly, it never dawned on me how the hexaxial…
2014-09-13 15:27:21
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