BMJ 2015;351:h3512 doi: 10.1136/bmj.h3512 (Published 9 July 2015)

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Endgames

ENDGAMES SPOT DIAGNOSIS

Twelve lead electrocardiography after collapse 1

Ben Lovell specialty registrar , Hilary Connor consultant in emergency medicine

2

Department of Acute Medicine, Royal Free Hospital, London NW3 2CG, UK; 2Emergency Department, Royal Free Hospital

1

In the percutaneous coronary intervention unit the patient had a heart rate of 45 beats/min and a blood pressure of 70/40 mm Hg, neither of which responded to atropine and fluid resuscitation. His Glasgow coma score (GCS) was recorded as 7/15.

was initially recorded as 27ºC. The hypothermia was due to severe sepsis, combined with immobility as a result of Parkinson’s disease.

Question

What does the 12 lead electrocardiograph show (fig 1), and what urgent treatment is needed?

Fig 2 Twelve lead electrocardiograph showing a tremulous baseline (arrow A), marked J waves (arrow B), bradycardia, and prolonged QTc (arrow C) Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

Answer The electrocardiograph shows a tremulous baseline, marked J waves, bradycardia, and prolonged QTc interval in keeping with profound hypothermia (fig 2). The patient’s core temperature

Provenance and peer review: Not commissioned; externally peer reviewed. Patient consent obtained. Cite this as: BMJ 2015;351:h3512 © BMJ Publishing Group Ltd 2015

Correspondence to: B Lovell [email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions

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