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71 year old intoxicated patient found lying outside in the cold. Core temp 83 degrees.


The Osborn wave (J wave) is a positive deflection seen at the J point in precordial and true limb leads. It is most commonly associated with hypothermia. These changes will appear as a reciprocal, negative deflection in aVR and V1.


Osborn Wave Causes

Characteristically seen in hypothermia (typically T < 30C), but they are not pathognomic. Causes of non-hypothermic Osborn waves include:

No definitive physiological cause for the deflection has been described, despite numerous postulates.

Compared to other hypothermia-induced ECG abnormalities (e.g. sinus bradycardia; supraventricular arrhythmias, QT prolongation and AV block), the Osborn wave is thought to be the most specific.

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The Provider Contact List has been updated and can be found in the adminitrative section of the website (see Administrative tab above).


Instructions for initial setup of NCDAVE (North Carolina Vital Records - used to fill out Death Certificates) has also been added to the Administrative Section of the website.

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This patient presented with intermittent chest pain and had an initial troponin of 18,000. This patient has concordant ST elevation in I and II, as well as excessive discordant elevation in V2-V4. The patient had a 99% mid-to-distal LAD lesion that was successfully stented.


The following is a review of the Sgarbossa Criteria for acute MI in patients with a LBBB (old or new).




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