Question: elderly woman presents to the hospital with altered mental status and this ECG.  Should the cath lab be activated? What do you think is going on?

Answer: Don't activate the cath lab.  The patient had hypothermia with a core temperature of 30C.  Osborne waves are notable (especially in V3).  Other features of hypothermia include sinus bradycardia and first-degree AV block. The ST elevation in V2 reflects a pseudoinfarction pattern due to hypothermia.  Hypothermia can also cause a Brugada pattern, but I don't think this is truly a Brugada pattern (V2 resembles a saddleback, but this is merely due to a superposition of ST elevation with an Osborne wave).

Clinical management: Echocardiography revealed normal ventricular function. Troponin was negative. With rewarming, this ECG pattern disappeared.

Further discussion of ECG changes in hypothermia here.