So why do we think she ended up in the Emergency Department based on the ECG ?
Check out the comments on our original post here.
|Click to enlarge|
- ~48 bpm
- No p waves visible
- QRS - Prolonged (~180ms)
- QT - 720ms
- Inferior ST sagging
- RBBB Morphology
- Osborn J waves
- Prominent U waves best seen infero-laterally
- T wave inversion leads aVR, aVL, V1-3
|ECG with T, U and J waves labelled|
Click to enlarge
- Slow Atrial Fibrillation
- Prominent U waves
Differentials for this ECG
Without more clinical information it's difficult to give a firm conclusion. I think this ECG is most consistent with hypothermia but some features could be explained by drug toxicity (digoxin, CCB's, beta-blockers), electrolyte abnormalities, ischemia, sinus node dysfunction. We should be mindful in the elderly that the clinical situation is often multi-factorial and could be a combination of the above causes. Also remember hypothermia in the elderly has a multitude of potential causes including environmental, sepsis and endocrine.
New Team Member
I'd like to welcome Dr Richard McClelland to our ECG blogging team - Richard is a EM registrar in Australia planning to continue his training back in the UK.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.