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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Comments
Eric Strong
Axis Determination – Part VI
This is a great discussion of axis determination. One minor suggestion: I think it's potentially misleading to refer to an axis between 0 and -30 as "physiologic left axis deviation", since "axis devitation" implies deviation from normal, and axes between 0 and -30 are perfectly normal, (depending on age and body habitus). It may be…
2014-10-05 17:09:00
Ian
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Can you give me a little more info on hypervagotonia? I googled around for some info but there doesn't seem to be much info and it's a term I've never heard before. Thanks!
2014-10-05 15:09:24
68 y.o. male w/ weakness: conclusion – “Treat the monitor.” | EMS 12 Lead
HyperK and Shades of Grey: Myths and Facts about Hyperkalemia Part I
[…] Myths about hyperkalemia […]
2014-10-05 01:54:53
68 y.o. male with weakness: “Treat the monitor, not the patient?” | EMS 12 Lead
68 y.o. male w/ weakness: conclusion – “Treat the monitor.”
[…] The conclusion, with the diagnosis, is now available. Click to go […]
2014-10-05 01:36:36
SFL Medic
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Destination: ED with most to offer. He's 68 and weak. I'm in Florida...we have people with their favorite Dx on their car tags around here, so that doesn't bother me. Neither does diminished lungs. Altered mental status does. And the ECG looks like an old oscilloscope...which I've used in the field (MRL)...which tells me high…
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