ECG TRAINING MODULE 2

1. ECG TRAINING MODULE 2 BY BRAD CHAPMAN RCT

2. OBJECTIVES • PATIENT APPROACH • LEAD PLACEMENT • ARTIFACT • SPECIAL NEEDS PATIENTS

3. The Approach • Enter to the left hand side of the patient • Ensure them that this test doesn't hurt • Make sure curtain is pulled across for the women • Ask the Men if they want the curtain pulled – most won't but occasional one will

4. Patient Preparation • Tell patient that you are going to place stickers on them and then connect some wires • Start by placing a sticker on either the arms or legs first – this helps to show that this test is non-invasive and helps to relieve anxiety

5. Placement of Leads • Find the first intercoastal space by moving a finger down the right collar bone towards the sternum. Stop a ½ “ before the sternum • Rock fingers down chest counting the intercostal spaces • Count down to the 4th intercostal space • Place a sticker there • Repeat process on the other side of the sternum

6. Placement of leads • Draw a vertical line from mid-clavicular to under the breast and place a sticker. This will be V4. • Place sticker in between v2 and v4 • This sticker would be on a diagonal plane between v2 and v4 • Visual drop a horizontal line straight line down from v4 to mid-auxilla and place a sticker (v6) • Place a sticker between v4 and v6 – this will be your v5 lead

8. Chest Lead Placement • All chest leads are labelled v1, v2, v3,...v6. • All leads are color coded. • Chest leads are • Red • Yellow • Green • Blue • Orange • Purple

9. Easy to remember • Stop Light • Red, Yellow, Green • BOP • Blue, Orange, Purple

10. Artifact • There are different types of artifact • Somatic tremors (muscle artifact) – most common • Wandering baseline • AC interference

11. Somatic Tremors (Muscle artifact) CAUSE • Most common type of artifact • Caused by patient moving limbs, fingers, nervous, restless, or anxious REMEDY • Try to have the patient relax and hold still • Try talking in a calming voice while doing the tracing • Move limb stickers higher up the limb

12. Wandering Baseline CAUSE • Patient is moving or stickers are not making a good contact • Cables may be dangling or swaying REMEDY • Place a towel on chest leads to weight them down • Apply pressure to lead with a towel

13. AC Interference • Consistent and regular saw tooth pattern REMEDY • Turn off all cell phones and other electronic devices (possibly lights) • Unplug electric bed • TENS machines must be turned off to do ECG • Place ECG machine further away from ventilators, IV pumps • X-Ray equipment • Radio and TV

15. Where is that Artifact coming from? If there is artifact in Check this connection these leads • Lead I and II RA • Lead I and III LA • Lead II and III LL • OR • Tap on or shake the limb lead and see where the interference is coming from

16. Special Needs Patient • Amputees • Burns • Tremors • Paediatrics • Wheelchair • Trauma • SOB • Acute MI • Psychiatric

17. AMPUTEES • Place lead further up the limb or even on the hip or shoulder • You can put both leg leads on the left leg as long as the left lead is higher up the leg then the right leg lead

18. BURNS • Place leads on parts of the skin that are not burnt • Do not remove any clothing that is stuck to the skin • Take alligator clip off the end of the lead, clean with alcohol and hold the tip of the lead on the skin lightly

19. TREMORS • Parkinson’s disease • Place hands underneath the buttocks • Place electrodes on Hips or Shoulders • Add extra pillow under knees

20. PEDIATRICS • Getting small children to hold still during an ECG may be challenging • Distraction with toys or Music • Young infants, place stickers on then wrap in a blanket

21. WHEELCHAIR • Assist to transfer to bed • If they can’t move to bed – do ECG in the chair • Record on the ECG that done while sitting up. (Changes the axis of the heart)

22. TRAUMA • Remain calm – work at putting on stickers while the medical team does their task • Place your stickers on and hook up wires • Communicate to the trauma team when you are ready to acquire the tracing • When ready tell the trauma team not to move them for 10 seconds

23. RESPIRATORY DISTRESS • The patient in respiratory distress is difficult to obtain an ECG on • You may have to have them in sitting position – just remember to record a comment on the ECG • Place limb leads higher up (Shoulders & Hips)

24. CHEST TUBES • Place all electrodes you can without moving bandages • You will probably have to leave leads V5 and V6 off • Take extra precautions around the chest tube. Seek help if it appears to be loose.

25. ACUTE MYOCARDIAL INFARCTION • Remain calm • Leave stickers on if you will be doing serials ECG’s. This will accurately measure changes due to MI and not movement

26. PSYCHIATRIC • Be very reassuring when it comes to explaining the exam • Explain the test in layman terms • Never use the word “electro” • Always call an ECG a “Cardiogram” or Heart Tracing • ECG sounds like ECT (shock therapy)

27. REVIEW QUIZ! • Thank you for your time.