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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Comments
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45
Dustin
83 Year Old Male: Shortness of Breath
I see a very sick and complicated patient. 12 Lead: ST elevation in AVR and V1 along with depression in I, II, V4-V6 leading me to an LMCA occlusion. The tall R wave in V2 also points me to Posterior involvement. Posterior MIs and LMCA occlusions can and do cause pulmonary edema, which this patient…
2014-10-30 02:38:21
Adrian
83 Year Old Male: Shortness of Breath
Firstly, the patient is septic, he needs high flow O2 (which he's already receiving), IV fluids, blood cultures and antibiotics (most likely IV) and needs to be in resus sharpish. Secondly, the ECG needs doing again, V2 is wrong and I'm not sure where it's been placed to get that reading. Assuming the rest of…
2014-10-30 01:00:42
Ken Grauer, MD
83 Year Old Male: Shortness of Breath
I see a regular rhythm at ~ 95/minute with LOTS of baseline artifact. I am not certain if there are P waves or not ..... It does look in leads V3,V4 like there are P waves with a long PR interval - but I cannot be certain in lead II that there is an upright…
2014-10-30 00:59:40

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