0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Challenges in Clinical Electrocardiography |

Possible Acute Myocardial Infarction in a Hypothermic Patient

Stephen W. Waldo, MD; Kathryn Treit, MD; Nora Goldschlager, MD
Arch Intern Med. 2011;171(16):1430. doi:10.1001/archinternmed.2011.404.
Text Size: A A A
Published online

Extract

A 50-year-old man was brought to the hospital by ambulance after being found unresponsive in his home. Information obtained from an acquaintance indicated the patient was in his usual state of health until 1 day prior to presentation when he threatened to consume a “stash” of benzodiazepines. The patient was found lying unresponsive in his apartment the following afternoon. After being intubated in the field for airway protection, the patient was transported to the emergency department for further evaluation. Past medical history obtained through a chart review was notable for human immunodeficiency virus infection, bipolar disorder, and a seizure disorder. Outpatient medications included lamotrigine, lithium, and trazodone. On presentation to the emergency department, the patient was unresponsive without corneal or gag reflexes. Vital signs were notable for moderate hypothermia (29.8°C) and a normal heart rate (70/min) and blood pressure (110/60 mm Hg). Findings from physical examination were notable for coarse breath sounds and a normal cardiac examination. The extremities were cool with palpable pulses. Initial laboratory investigations revealed a respiratory acidosis (pH 7.21) and an elevated lactate (3.8 mg/dL). A urine toxicologic test result was positive for benzodiazepines. An electrocardiogram (ECG) was obtained (Figure 1).

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Acute Myocardial Infarction

brightcove.createExperiences();