The key role of ECG in diagnosing secondary hypothermia in a patient with shock: a case report

Even if hypothermia is described as one of the main causes of cardiac arrest, in medical literature, it is not often mentioned as a main cause of shock. Nevertheless, it is known to contribute to shock development, maintenance, and worsening of its prognosis by lowering cardiac performance and blood pressure; this is particularly relevant in sepsis. Diagnosing hypothermia can be challenging, especially in patients not suffering an obvious environmental exposure. Digital medical thermometers cannot accurately estimate hypothermia, so when suspected, the placement of an esophageal thermometer is indicated. Below 32°C, the electrocardiogram (ECG) often shows a characteristic elevation of the J point called the Osborne wave (OW). We present a case of a patient with mixed shock in which this electrocardiographic disturbance allowed for an early suspicion of hypothermia, enabling prompt initiation of adequate treatment.