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August 2005 EKG Case Answers A 64 year old homeless male is brought in by EMS found unconscious on a park bench. Rate: between 30-50 EKG diagnosis: Atrial fibrillation with slow ventricular response and J (Osbourne) waves Clinical diagnosis: Hypothermia Profound hypothermia (core temperatures < 32 C) causes peripheral vasoconstriction, impaired enzymatic activity, decreased cardiac output, and reduced respirations. Complications include aspiration pneumonia, adult respiratory distress syndrome, pulmonary edema, rhabdomyolysis, acute tubular necrosis, gastric dilatation, upper GI bleed, hyperviscosity syndrome, and DIC. The classic EKG finding of hypothermia is the Osbourne wave (or J wave), which is an extra positive deflection between the terminal portion of the QRS complex and the beginning of the ST segment. The Osbourne wave is usually positive in the left precordial leads, and has an amplitude that is inversely proportional to body temperature. Other EKG changes caused by hypothermia include prolongation of the PR, QRS, and QT intervals, T wave inversion, and bradyarrythmias consisting of sinus bradycardia, junctional rhythm, or atrial fibrillation with a slow ventricular response.
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