Hypothermia: ECG Findings, Checklists and Debriefing with Dr Sush Prusty

Dr Sush Prusty is the director of EMS at Steward St. Elizabeth’s Medical Center and assistant professor of emergency medicine at Tufts University School of Medicine in Boston, Massachusetts. He also serves as the medical director for Boston College EMS as well as local EMS agencies. Dr Prusty earned his medical degree from Boston University School of Medicine and completed his residency at Boston Medical Center. He is board certified in Emergency Medicine and is currently an emergency department attending at Steward St. Elizabeth’s Medical Center. In addition, he is an FAA Flight instructor, holds a commercial pilot certificate, and, has over ten years of service in the U.S. Army as a Flight surgeon. Having a special interest in aviation safety, he has taught widely in the areas of crew resource management, human factors, and debriefing techniques.

Today’s topic started with a case; an 18-year-old college student found in a snowbank with severe hypothermia. Stephen and Dr Prusty review the definition of hypothermia and how to diagnose it. They remind us on the importance of having a solid differential diagnosis as well as the importance of accurate thermometry. ECGs are the topic of discussion, including the classic finding of the Osborn wave. They delve into the history, pathophysiology and relevance of this wave. The discussion of ECGs leads to management of cardiac arrest and management of severe hypothermia. Coming back to the case, after some follow up on the clinical course, the discussion leads to the use of checklists for low- frequency cases. Dr. Prusty is an expert on debriefing and he discusses his methods for debriefing that include ensuring each team member recognizes the importance of their role. He also discusses how he integrates wellness into his debriefings.