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MAKING ECG ’ S EASY. APPLICATION FOR THE ECG EVALUATING THE ECG . Upon completion one will be able to:. Describe what an ECG is. Describe the proper hook-up procedure for a 12-Lead ECG Identify basic normal ECG waveform morphology. Distinguish between basic ECG arrhythmia and artifact. .

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Making ecg s easy l.jpg

MAKING ECG’S EASY

APPLICATION FOR THE ECG

EVALUATING THE ECG


Upon completion one will be able to l.jpg
Upon completion one will be able to:

  • Describe what an ECG is.

  • Describe the proper hook-up procedure for a 12-Lead ECG

  • Identify basic normal ECG waveform morphology.

  • Distinguish between basic ECG arrhythmia and artifact.


Quick review of heart l.jpg
QUICK REVIEW OF HEART

Purpose

  • Pumps blood

    Basic Anatomy

  • 4 chambers

  • 2 sides

  • 4 valves


The conductingy system l.jpg
THE CONDUCTINGY SYSTEM

  • SA Node

  • Inter-nodal pathway

  • AV Node

  • Bundle of HIS

  • Bundle Branches

  • Purkinje Fibers




12 lead ecg l.jpg
12 LEAD ECG

Learning objectives:

Describe the correct

placement of all electrodes

Proper Skin preparation

Care of the ECG machine, wires and electrodes


Principles of electrocardiograph l.jpg
Principles of Electrocardiograph

  • Electrocardiograph – is the instrument that records the electrical activity of the heart

  • Electrocardiogram (ECG) is the record of that activity


Hooking up the 12 lead ecg l.jpg
HOOKING UP THE 12-LEAD ECG

  • Proper skin prep

  • Placement of the limb electrodes

  • Placement of the chest electrodes


Skin preparation l.jpg
SKIN PREPARATION

  • REASON FOR SKIN PREPARATION

  • 5 STEP METHOD

  • 2 STEP METHOD


Electrode placement l.jpg
ELECTRODE PLACEMENT

  • LIMB LEADS

  • CHEST LEAD


Limb leads l.jpg
LIMB LEADS

  • Bipolar leads

    I II III

  • Augment leads

    Avr Avl Avf


Chest leads l.jpg

6 UNIPOLAR LEADS

V1

V2

V3

V4

V5

V6

CHEST LEADS


Lets review l.jpg
LETS REVIEW

  • What is an ECG

  • What are the limb leads?

  • What are the chest leads?

  • Why do skin prep?



Information on the ecg l.jpg
INFORMATION ON THE ECG

  • Patients demographics

  • Heart rate and measurements

  • Speed ECG is recorded at

  • Voltage ECG is recorded at

  • What the filter is set on



What you need to look for l.jpg
WHAT YOU NEED TO LOOK FOR

  • Are the limb leads hooked up correctly?

  • Are the chest leads hooked up correctly?

  • Is the ECG free of artifact.

  • Is this ECG a Critical Value


Is the ecg hooked up correctly l.jpg

LIMB LEADS

Normal 12-lead

AVR – always negative

Lead I – always positive

Lead II, III – positive or biphasic

CHEST LEADS

COLUMN III

R wave progression

Small to Tall

COLUMN IV

R wave progression

Tall to Small

IS the ECG HOOKED UP CORRECTLY?


Ruling out limb lead reversal l.jpg
RULING OUT LIMB LEAD REVERSAL

  • Avr is always negative

  • Lead I is always positive

  • Lead II and III positive for the P wave and usually the QRS complex


Chest leads21 l.jpg
CHEST LEADS

CHEST LEADS

COLUMN III

  • R wave progression

  • Small to Tall

    COLUMN IV

  • R wave progression

  • Tall to Small




Other problems with the ecg l.jpg
OTHER PROBLEMS WITH THE ECG

  • Artifact

  • Electrical interference

  • Somatic tremor

  • Wandering baseline








Basic critical values l.jpg
BASIC CRITICAL VALUES

  • Bradycardia – HR < 40bpm

  • Tachycardia HR > 120bpm

  • PVC’s - 4 or more in a row

  • ST Elevation


Looking at the rhythm l.jpg

Evaluate the rhythm strip at the bottom of the 12-lead for the following

Is the rhythm regular or irregular?

Is there a P wave before every QRS complex

Are they any abnormal beats.

LOOKING AT THE RHYTHM


Finding the heart rate l.jpg
FINDING THE HEART RATE the following

  • 3 METHODS

  • RATE RULER

  • COUNTING

  • BOX METHOD


Box method l.jpg
BOX METHOD the following


Ectopic beats l.jpg
ECTOPIC BEATS the following


Ectopic beats44 l.jpg
ECTOPIC BEATS the following


Lets summarize l.jpg
LETS SUMMARIZE the following

How do we produce an excellent 12-lead ECG?

Proper skin prep

Correct electrode placement

Recognize and know how to correct problems

Recognize basic critical values


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