# 遊民來院核心溫度28.4°C、嗜睡、HR 38、BP 86/52、ECG出現Osborne(J)波。適當處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375136&lang=zh-tw  
> language: zh-TW  
> subject: Physiological Adaptation  
> category: PA

## 題目

遊民來院核心溫度28.4°C、嗜睡、HR 38、BP 86/52、ECG出現Osborne(J)波。適當處置?複選。

1

溫和處置以免誘發VF

2

脫去濕衣並使用強制空氣加溫毯(Bair Hugger)

3

若心停且ACLS無效預期可能ECMO

4

以中央或大口徑末梢IV給予加溫晶體液

5

外部冷卻使體溫迅速下降

## 解析

重度低體溫(<28°C)處置:溫和處置(粗暴動作誘發VF)、脫濕衣、主動中央加溫(強制空氣毯、40-42°C加溫IV、加溫加濕氧、必要時體腔灌洗、若停跳/不穩用ECMO/CPB — 最有效6-10°C/小時)。Osborne(J)波具特徵性。加溫期間持續CPR — 「未變暖之前不算死」。外部冷卻錯誤 — 病人為低體溫非高體溫。

## 深入解析

ECMO/CPB為重度低體溫停跳之黃金標準 — 即使停跳時間較長,若低體溫先發生仍有合理存活。

## 臨床情境

重度低體溫。濕衣。無明顯外傷。

## 重要概念

- **意外性低體溫** — 非預期之核心溫度低於35°C。
- **Osborne波** — QRS-ST交界處正向偏位 — 低體溫典型ECG徵象。
- **主動中央加溫** — 重度低體溫之內部加溫技術(加溫液、灌洗、ECMO)。

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