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Falat C. Environmental Hypothermia. Emerg Med Clin North Am 2024; 42:493-511. [PMID: 38925770 DOI: 10.1016/j.emc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Although a rare diagnosis in the Emergency Department, hypothermia affects patients in all environments, from urban to mountainous settings. Classic signs of death cannot be interpreted in the hypothermic patient, thus resulting in the mantra, "No one is dead until they're warm and dead." This comprehensive review of environmental hypothermia covers the clinical significance and pathophysiology of hypothermia, pearls and pitfalls in the prehospital management of hypothermia (including temperature measurement techniques and advanced cardiac life support deviations), necessary Emergency Department diagnostics, available rewarming modalities including extracorporeal life support, and criteria for termination of resuscitation.
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Affiliation(s)
- Cheyenne Falat
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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2
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Kaneko M, Ohara K, Shikata H. A case of fatal myxedema coma with electrocardiogram Osborne J-wave in a patient initially diagnosed with hypothyroidism. Endocr J 2022; 69:1109-1115. [PMID: 35400676 DOI: 10.1507/endocrj.ej21-0720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Myxedema coma is a life-threatening endocrine emergency with a high mortality rate resulting from severe insufficiency of thyroid hormones. Intravenous levothyroxine replacement is considered the standard therapy for myxedema coma in many countries. In Japan, however, although there are diagnostic criteria highly suggestive or diagnostic for myxedema coma, no management strategy has been established, despite the availability of levothyroxine. Here we report a 75-year-old man with a history of Alzheimer's disease and schizophrenia who developed somnolence and generalized edema. Except for a pulse rate of 60 bpm, his vital signs and blood oxygen level were stable. Thyroid studies showed an elevated serum thyrotropin level of 219.2 μU/mL and a decreased serum free-thyroxine level of 0.15 ng/dL. On this basis he was diagnosed as having hypothyroidism rather than being highly suggestive for myxedema coma. Daily oral levothyroxine 25 μg was initiated and increased to 50 μg 3 days later. Seven days after being started on levothyroxine, the patient suddenly developed impaired consciousness, hypoxemia, hypotension, hypothermia, and hyponatremia. Electrocardiography revealed junctional bradycardia with Osborne J-wave. Myxedema coma was therefore diagnosed. He went into cardiac arrest in the emergency room but was resuscitated. Despite subsequent intravenous administration of hydrocortisone and levothyroxine, as well as intensive supportive care, he eventually died 12 hours after hospital admission. This case illustrates some of the challenges associated with the management of patients with signs highly suggestive/diagnostic of myxedema coma, including the optimal loading dosage and intervention timing of thyroid hormone replacement.
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Affiliation(s)
- Masahiko Kaneko
- Department of Internal Medicine, Uwajima City Hospital, Ehime 798-8510, Japan
| | - Kentarou Ohara
- Postgraduate Clinical Training Center, Uwajima City Hospital, Ehime 798-8510, Japan
| | - Hisaharu Shikata
- Department of Internal Medicine, Uwajima City Hospital, Ehime 798-8510, Japan
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3
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Zaki HA, Alhatemi M, Hendy M, Kaber Y, Iftikhar H. A Case of New-Onset Atrial Fibrillation With Rapid Ventricular Response Due to Iatrogenic Hypothermia. Cureus 2022; 14:e23822. [PMID: 35530850 PMCID: PMC9068162 DOI: 10.7759/cureus.23822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Hypothermia is an involuntary fall in body temperature, usually below 35°C. Hypothermia is a common condition, especially in frigid zones. However, it should not be forgotten that it can also occur in temperate climates or for iatrogenic reasons. Hypothermia is associated with seriously severe arrhythmias, particularly ventricular fibrillation, and there are many reports of prolonged resuscitation in these patient groups. This case report shows that a standard thermometer, either with Emergency Medical Services or in-hospital, will be incapable of reading the temperature if it is less than 34°C and will falsely read 34°C when in reality it is lower than that; in a clinically relevant scenario, a low-reading thermometer or core body temperature readings, such as rectal or esophageal, should be used.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Mohamed Hendy
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Yasser Kaber
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Haris Iftikhar
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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Dietrichs ES, Tveita T, Smith G. Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data. Cardiovasc Res 2020; 115:501-509. [PMID: 30544147 DOI: 10.1093/cvr/cvy305] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
Moderate therapeutic hypothermia procedures are used in post-cardiac arrest care, while in surgical procedures, lower core temperatures are often utilized to provide cerebral protection. Involuntary reduction of core body temperature takes place in accidental hypothermia and ventricular arrhythmias are recognized as a principal cause for a high mortality rate in these patients. We assessed both clinical and experimental literature through a systematic literature search in the PubMed database, to review the effect of hypothermia on cardiac electrophysiology. From included studies, there is common experimental and clinical evidence that progressive cooling will induce changes in cardiac electrophysiology. The QT interval is prolonged and appears more sensitive to decreases in temperature than the QRS interval. Severe hypothermia is associated with more pronounced changes, some of which are proarrhythmic. This is supported clinically where severe accidental hypothermia is commonly associated with ventricular fibrillation or asystole. J-waves in human electrocardiogram recordings are regularly but not always observed in hypothermia. Its relation to ventricular repolarization and arrhythmias is not obvious. Little clinical data exist on efficacy of anti-arrhythmic drugs in hypothermia, while experimental data show the potential of some agents, such as the class III antiarrhythmic bretylium. It is apparent that QT-prolonging drugs should be avoided.
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Affiliation(s)
- Erik Sveberg Dietrichs
- Department of Medical Biology, Experimental and Clinical Pharmacology Research Group, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Diagnostic Services, Department of Clinical Pharmacology, University Hospital of North Norway, Tromsø, Norway
| | - Torkjel Tveita
- Department of Clinical Medicine, Anesthesia and Critical Care Research Group, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Godfrey Smith
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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Murakami T, Yoshida T, Kurokochi A, Takamatsu K, Teranishi Y, Shigeta K, Tamaki S, Morita S, Mizuno R, Oya M. Accidental Hypothermia Treated by Hemodialysis in the Acute Phase: Three Case Reports and a Review of the Literature. Intern Med 2019; 58:2743-2748. [PMID: 31178478 PMCID: PMC6794177 DOI: 10.2169/internalmedicine.1945-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accidental hypothermia is defined as a core body temperature <35°C. Even with the use of multiple active rewarming methods, it has a high mortality rate. No standard treatment strategy for moderate or severe hypothermia in the absence of cardiac arrest has yet been established. We herein report three patients with severe or moderate accidental hypothermia who were treated by hemodialysis in the acute phase. This case report with a literature review describes the usefulness of hemodialysis for the treatment of moderate and severe accidental hypothermia without cardiac arrest.
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Affiliation(s)
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Arata Kurokochi
- Department of Internal Medicine, Keio University School of Medicine, Japan
| | | | - Yu Teranishi
- Department of Urology, Keio University School of Medicine, Japan
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Japan
| | - Satoshi Tamaki
- Department of Urology, Keio University School of Medicine, Japan
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, Japan
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Japan
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6
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Elia F, Chiarlo M, Verhovez A. Heart of ice. Eur J Intern Med 2019; 62:e1-e2. [PMID: 30001866 DOI: 10.1016/j.ejim.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Fabrizio Elia
- High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy.
| | - Michela Chiarlo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Verhovez
- High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy
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Aléx J, Uppstu T, Saveman BI. The opinions of ambulance personnel regarding using a heated mattress for patients being cared for in a cold climate - An intervention study in ambulance care. Int J Circumpolar Health 2017; 76:1379305. [PMID: 28990464 PMCID: PMC5645772 DOI: 10.1080/22423982.2017.1379305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of the study was to describe the opinions of ambulance personnel regarding differences between using a heated mattress and a standard ambulance mattress. This study was an intervention study with pre- and post-evaluation. Evaluations of the opinions of personnel regarding the standard unheated mattress were conducted initially. After the intervention with new heated mattresses, follow-up evaluations were conducted. Ambulance personnel (n=64) from an ambulance station in northern Sweden took part in the study, which ran from October 2014 until February 2016. There were differences in opinions regarding the standard unheated mattress and the new heated mattress. The evaluation of the proxy ratings by the personnel showed that the heated mattress was warmer than the standard mattress, more pleasant to lie on and that patients were happier and more relaxed than when the standard mattress was used. The ambulance personnel in this study rated the experience of working with the heated mattress as very positive and proxy rated that it had a good effect on patient comfort. A heated mattress can be recommended for patients in ambulance care, even if more research is needed to receive sufficient evidence.
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Affiliation(s)
- Jonas Aléx
- a Department of Nursing and affiliated with the Arctic Research Centre at Umeå University, Research fields: Prehospital emergency care , Umeå University , Umeå , Sweden
| | - Tom Uppstu
- b Department of Nursing , Umeå University , Umeå , Sweden
| | - Britt-Inger Saveman
- a Department of Nursing and affiliated with the Arctic Research Centre at Umeå University, Research fields: Prehospital emergency care , Umeå University , Umeå , Sweden
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Omar HR, El-Khabiry E, Tripathi N, Mangar D, Camporesi EM. Hypothermic Osborn waves without shivering artifacts: causes and implications. Ther Adv Endocrinol Metab 2016; 7:229-232. [PMID: 28203359 PMCID: PMC5298361 DOI: 10.1177/2042018816680588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ehab El-Khabiry
- Department of Internal Medicine, OSF Saint Anthony Medical Center, Rockford, IL, USA
| | - Nishant Tripathi
- Internal Medicine Department, Ottumwa Regional Health Center, IA, USA
| | - Devanand Mangar
- Chief of Anesthesia, Tampa General Hospital; CEO, FGTBA and Regional Medical Director, TEAMHealth, Tampa, FL, USA
| | - Enrico M. Camporesi
- Emeritus Professor, University of South Florida, FGTBA and TEAMHealth, Tampa, FL, USA
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Pelechas E, Tsigaridas N, Kyrama S, Trogganis S, Kardamis C. Electrocardiographic Manifestations in three Psychiatric patients with Hypothermia - Case Report. Hellenic J Cardiol 2016; 57:S1109-9666(16)30149-X. [PMID: 27780666 DOI: 10.1016/j.hjc.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 06/26/2015] [Indexed: 11/30/2022] Open
Abstract
Hypothermia occurs when the core body temperature falls below 35°C, which, in severe cases, can lead to electrocardiographic changes. Several conditions that occur in the psychiatric population increase the risk of hypothermia. This risk can be further increased by the use of several classes of medications such as antipsychotics, beta-adrenergic antagonists and benzodiazepines. We report on three psychiatric patients who were admitted for hypothermia and developed electrocardiographic manifestations (sinus bradycardia, QT prolongation and Osborn waves), which completely resolved after treatment.
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Affiliation(s)
- Eleftherios Pelechas
- Accident and Emergency Department, Scarborough General Hospital, United Kingdom.
| | | | - Sofia Kyrama
- Department of Cardiology, General Hospital of Arta, Greece
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10
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The effect of various stages of hypothermia on the ECG. Cardiovasc Endocrinol 2016. [DOI: 10.1097/xce.0000000000000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Kim CY, Bae MH, Kim NK, Yang YA, Kim KY, Lee JH, Eun JS, Cho Y. Case of Recurrent Ventricular Fibrillations with Osborn Wave Developed during Therapeutic Hypothermia. Korean Circ J 2015; 45:81-4. [PMID: 25653709 PMCID: PMC4310985 DOI: 10.4070/kcj.2015.45.1.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 01/09/2023] Open
Abstract
Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and individual difference in response of TH.
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Affiliation(s)
- Chang-Yeon Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Nam Kyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Ae Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kyu Yeun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jung Su Eun
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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Swiniarski GV, Mah J, Bulbuc CF, Norris CM. A comprehensive literature review on hypothermia and early extubation following coronary artery bypass surgery. Appl Nurs Res 2014; 28:137-41. [PMID: 25448056 DOI: 10.1016/j.apnr.2014.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/12/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to comprehensively review the literature addressing the physiological effects of hypothermia and its association with the appropriate core body temperature for extubation following coronary artery bypass surgery. METHODS The electronic databases MEDLINE, CINAHL and Web of Science via OVID were used to identify studies for the literature review. Search words used included 'core temperature', 'arrhythmia', 'cardiac', 'cardiac surgery', 'hypothermia', 'extubation', 'temperature', 'rewarming', and 'shivering'. RESULTS The literature search yielded 55 articles that met our inclusion criteria. No studies specifically identified the benefit of extubation at 36.5 ° C. Although temperatures varied, arrhythmias resulting from hypothermia were not reported until core body temperature dropped below 33 ° C. CONCLUSION This comprehensive literature review suggests extubation at lower temperatures (between 34 ° C and 36 ° C) may be viable if shivering and other factors known to contribute to myocardial stress can be controlled. These findings offer the possibility of earlier extubation which may promote beneficial health outcomes.
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Affiliation(s)
| | - Jean Mah
- Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada
| | | | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2G3, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada; Division of Cardiovascular Surgery, University of Alberta, Edmonton, AB T6G 2G3, Canada.
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Chhabra L, Devadoss R, Liti B, Spodick DH. Electrocardiographic changes in hypothermia: a review. Ther Hypothermia Temp Manag 2014; 3:54-62. [PMID: 24837798 DOI: 10.1089/ther.2013.0003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hypothermia is a common environmental emergency encountered by physicians and is associated with a variety of electrocardiographic (ECG) abnormalities. The classic and well-known ECG manifestations of hypothermia include the presence of J (Osborn) waves, interval (PR, QRS, QT) prolongation, and atrial and ventricular arrhythmias. There are less well defined and known ECG signs of hypothermia, which in fact may simulate findings of acute coronary ischemia, Brugada syndrome, or even pericarditis. Although classical ECG changes seen in hypothermia certainly serve as an important clinical clue for prompt identification and management of this easily curable life-threatening entity, physicians should, however, be able to maintain a high suspicion for recognition and differentiation of less common ECG abnormalities encountered in hypothermia. This article aims to provide a detailed review of all the potential ECG abnormalities that may be encountered in accidental and iatrogenic hypothermia.
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Affiliation(s)
- Lovely Chhabra
- 1 Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts Medical School , Worcester, Massachusetts
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Higuchi S, Takahashi T, Kabeya Y, Hasegawa T, Nakagawa S, Mitamura H. J Waves in Accidental Hypothermia. Circ J 2014; 78:128-34. [DOI: 10.1253/circj.cj-13-0704] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Hideo Mitamura
- Departments of Cardiology, Tokyo Saiseikai Central Hospital
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15
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Omar HR. Reply. Intern Med J 2012. [DOI: 10.1111/j.1445-5994.2012.02959.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. R. Omar
- Internal Medicine Department; Mercy Hospital and Medical Center; Chicago Illinois USA
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Abstract
The J wave, also known as Osborn wave, is a deflection that can be observed on the surface ECG as a late delta wave, seen at the end of the QRS complex. In this case, a 75-year-old woman, after 1 day of continuous haemodialysis, showed a marked hypothermia (28.5°C) and severe hypokalaemia (1.7 mEq/l). Bradycardia was seen on the monitor and J waves were recognised on the ECG recording. After appropriate replacement of potassium and treatment of hypothermia, the J waves disappeared spontaneously.
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Abstract
Hypothermia is known to cause specific electrocardiographic (EKG) changes such as Osborne waves and bradycardia. We report diffuse ST segment depression, an atypical EKG change, in a patient with a core temperature of 29.4°C (85°F). This patient had no previous cardiovascular pathology, and his EKG changes resolved gradually with aggressive warming. We also discuss the pathophysiology and clinical significance of ST depression in the general population and the typical EKG changes in hypothermia patients.
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Childress MA, O'Connor FG, Levine BD. Exertional Collapse in the Runner: Evaluation and Management in Fieldside and Office-Based Settings. Clin Sports Med 2010; 29:459-76. [DOI: 10.1016/j.csm.2010.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- Ravi K Mareedu
- Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA.
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20
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Cardiovascular manifestations and ECG findings in hypothermia. COR ET VASA 2007. [DOI: 10.33678/cor.2007.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Souza D, Riera ARP, Bombig MT, Francisco YA, Brollo L, Filho BL, Dubner S, Schapachnik E, Povoa R. Electrocardiographic changes by accidental hypothermia in an urban and a tropical region. J Electrocardiol 2006; 40:47-52. [PMID: 17027018 DOI: 10.1016/j.jelectrocard.2006.08.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 08/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypothermia is defined as a condition in which core temperature (rectal, esophageal, or tympanic) reaches values below 35 degrees C. This may be accidental, metabolic, or therapeutic. The accidental form is frequent in cold-climate countries and rare in those with tropical or subtropical climate. The aim of this study was to evaluate electrocardiographic changes of patients with accidental hypothermia. METHODS In 59 patients with hypothermia, the following electrocardiogram parameters were analyzed: rhythm and heart rate (HR), P-wave characteristics, PR-interval duration, QRS-complex duration, presence of J wave and its location characteristics, polarity, voltage, aspect and its correlation with the degree of hypothermia, changes in T wave regarding its polarity and characteristics, duration of the QT interval corrected for HR using both Bazett and Friderica formulas, and possible presence of both supraventricular and ventricular arrhythmias were independently and blindly analyzed in the tracings by experienced cardiologists. RESULTS In 6 patients, electrocardiogram was normal. Sinus bradycardia was observed in 52.5% of the patients. J wave was present in 51 patients, and its voltage correlated inversely and was statistically significantly with the core temperature. Changes in T wave were observed in 47.4% of the cases. QT interval, adjusted for HR, was prolonged in 72.8% of the cases. Idioventricular rhythm was found in 6 cases, total atrioventricular block in 3 cases, and junctional rhythm and atrial fibrillation in 2 patients. CONCLUSIONS Electrocardiogram changes in accidental hypothermia are frequent and characteristic for this entity improving diagnosis in usually unconscious patients, and in many cases, it may be the diagnostic clue in patients with conscience deficit in emergency units, even in patients from a tropical climate where the population at risk may be exposed to temperatures below 20 degrees C.
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Affiliation(s)
- Dilma de Souza
- Escola Paulista de Medicina, UNIFESP, São Paulo CEP, Brazil
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22
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Hypothermia—potentially deadly all year round. JAAPA 2005. [DOI: 10.1097/01720610-200506000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Mustafa S, Shaikh N, Gowda RM, Khan IA. Electrocardiographic features of hypothermia. Cardiology 2005; 103:118-9. [PMID: 15665530 DOI: 10.1159/000083434] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 06/21/2004] [Indexed: 11/19/2022]
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Abstract
Hypothermia and localized cold injuries are largely preventable with proper preparation for activities in cold environments. Proficient field management is crucial to the final outcome in terms of function and viability because proper care is vital to preventing exacerbation of the initial exposure and injury. Rapid rewarming is optimal when further cold exposure can be avoided reliably. Repetitive freeze-thaw cycles are associated with increased morbidity and tissue loss caused by progressive microvascular injury and thrombosis. The subsequent care is largely supportive and consists of wound care and physical and hydrotherapy to promote optimal functional recovery.
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Affiliation(s)
- Andrew S Ulrich
- Department of Emergency Medicine, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA 02118, USA.
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