How would you manage this patient?

A woman was found outside with altered mental status.She was GCS 3.  BP 80/40Here is her ECG:Diagnosis?Sinus bradycardia with Osborn waves.  Temperature was 24.3 degrees Celsius.She was intubated (carefully, so as not to irritate her heart into ventricular fibrillation).She requiresinternal rewarming at this temperature.  External rewarming would be dangerous, as it results in both rewarming shock (hypotension/shock due to shunting of core blood flow to the surface) and " core afterdrop " (shunting of cold surface blood to the core, dropping core temperature).Because she has an appropriate blood pressure and perfusion, bypass or ECMO is not necessary at this point (but still might become necessary).This patient was rewarmed with thoracic cavity lavage and intravascular catheter, the same used for induced therapeutic hypothermia.  In this case, the Alsius catheter was placed.  The patient was warmed and did well.===================================MY Comment by KEN GRAUER, MD (1/2/2020):===================================This case provides an excellent example in which the History + recognition of Osborn Waves provide the essential clues to facilitate an instant diagnosis of severe Hypothermia. That said, in addition to bradycardia + Osborn waves — there are 2 other ECG findings in Figure-1 that should be noted and fol...

Source: Dr. Smith's ECG Blog - January 1, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs