Monday, May 23, 2016


You are an emergency physician attending in a busy ER. A resident comes up to you with this EKG and says it's from a person who was "found down." She administered atropine but there was no increase in heart rate.

Challenge: Why not?

Image shown under Fair Use.


Anonymous said...

Looks like a LBBB? New? Would need to r/o AMI

Craig Chen said...

weird looking EKG, right? what looks like a widened QRS is actually Osborn waves.

The EKG is consistent with systemic hypothermia; it shows sinus bradycardia with marked Osborn waves in V4 and V5 as well as T wave inversion and QT prolongation. According to a May 3, 2016 JAMA article, “bradycardia is not vagally mediated, so it can be refractory to atropine.”

Sources: JAMA, ECG Wave Maven.