The key role of ECG in diagnosing secondary hypothermia in a patient with shock: a case report
Abstract
Even if hypothermia is described as one of the main causes of cardiac arrest, in medical literature, it is not often mentioned as a main cause of shock. Nevertheless, it is known to contribute to shock development, maintenance, and worsening of its prognosis by lowering cardiac performance and blood pressure; this is particularly relevant in sepsis. Diagnosing hypothermia can be challenging, especially in patients not suffering an obvious environmental exposure. Digital medical thermometers cannot accurately estimate hypothermia, so when suspected, the placement of an esophageal thermometer is indicated. Below 32°C, the electrocardiogram (ECG) often shows a characteristic elevation of the J point called the Osborne wave (OW). We present a case of a patient with mixed shock in which this electrocardiographic disturbance allowed for an early suspicion of hypothermia, enabling prompt initiation of adequate treatment.
Keywords
References
- Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013;369:1726-34.
- Tveita T, Sieck GC. Physiological impact of hypothermia: the good, the bad, and the ugly. Physiology (Bethesda) 2022;37:69-87.
- Riera J, Argudo E, Ruiz-Rodríguez JC, et al. Full neurological recovery 6 h after cardiac arrest due to accidental hypothermia. Lancet 2020;395:e89.
- Mikhail J. The trauma triad of death: hypothermia, acidosis, and coagulopathy. AACN Clin Issues 1999;10:85-94.
- Standl T, Annecke T, Cascorbi I, et al. The nomenclature, definition and distinction of types of shock. Dtsch Arztebl Int 2018;115:757-68.
- Harmon MBA, Scicluna BP, Wiewel MA, et al.; MARS consortium. Patients with hypothermic sepsis have a unique gene expression profile compared to patients with fever and sepsis. J Cell Mol Med 2022;26:1896-904.
- Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med 2012;367:1930-8. Erratum in: N Engl J Med 2013;368:394.
- Papathanakos G, Póvoa P, Blot S. Early sepsis recognition: Is hypothermia the most neglected symptom? Intensive Crit Care Nurs 2024;84:103776.
- Liu VX, Fielding-Singh V, Greene JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med 2017;196:856-63.
- International Organization for Standardization. ISO 80601-2-56:2017(en): Medical Electrical Equipment — Part 2-56: Particular Requirements for Basic Safety and Essential Performance of Clinical Thermometers for Body Temperature Measurement. ISO, 2017.
- Lichtman AD. Osborn waves with ventricular fibrillation caused by hypothermia. Anesthesiology 2021;134:772-3.
- Muñoz Moreno JF, Rubio Prieto E, Espinosa González MC. Osborn’s J wave evolution in severe hypothermia. Med Intensiva 2022;47:482-3.
- Eroglu O, Serbest S, Kufeciler T, Kalkan A. Osborn wave in hypothermia and relation to mortality. Am J Emerg Med 2019;37:1065-8.
- Manzur-Sandoval D, Dueñas-Pérez G, Ortiz-Brizuela E, et al. Osborn J-Wave in a Patient with Hypercalcemic Crisis. J Em Med 2020;59:298-9.
- Cha KC, Ahn SG, Hwang SO. Ischaemia-induced Osborn waves. Eur Heart J Case Rep 2022;6.
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