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

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Alex
100 yof CC: Rib pain and intermittent spasms
>>Too perfectly lined up with the T-waves, while the isoelectric line is relatively stable, to be strictly movement artifact. Can these spasms be sync-d with (or caused by) mechanical movement of the heart walls?
2014-11-25 23:20:19
Erich
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Fantastic post, must see stuff for junior paramedics, medical students, residents and nurses that could potentially see cardiac arrest on a regular basis.
2014-11-25 16:22:28
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[…] http://www.ems12lead.com/2014/09/11/the-360-degree-heart-part-i/ […]
2014-11-25 09:01:37
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[…] you understand axis as well as you’d like? The EMS 12-Lead blog gives us the first in a new series on understanding axis on the ECG. […]
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