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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

MAKING ECG’S EASY

APPLICATION FOR THE ECG

EVALUATING THE ECG

upon completion one will be able to
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
QUICK REVIEW OF HEART

Purpose

  • Pumps blood

Basic Anatomy

  • 4 chambers
  • 2 sides
  • 4 valves
the conductingy system
THE CONDUCTINGY SYSTEM
  • SA Node
  • Inter-nodal pathway
  • AV Node
  • Bundle of HIS
  • Bundle Branches
  • Purkinje Fibers
12 lead ecg
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
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
HOOKING UP THE 12-LEAD ECG
  • Proper skin prep
  • Placement of the limb electrodes
  • Placement of the chest electrodes
skin preparation
SKIN PREPARATION
  • REASON FOR SKIN PREPARATION
  • 5 STEP METHOD
  • 2 STEP METHOD
electrode placement
ELECTRODE PLACEMENT
  • LIMB LEADS
  • CHEST LEAD
limb leads
LIMB LEADS
  • Bipolar leads

I II III

  • Augment leads

Avr Avl Avf

lets review
LETS REVIEW
  • What is an ECG
  • What are the limb leads?
  • What are the chest leads?
  • Why do skin prep?
information on the ecg
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
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
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
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
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
OTHER PROBLEMS WITH THE ECG
  • Artifact
  • Electrical interference
  • Somatic tremor
  • Wandering baseline
basic critical values
BASIC CRITICAL VALUES
  • Bradycardia – HR < 40bpm
  • Tachycardia HR > 120bpm
  • PVC’s - 4 or more in a row
  • ST Elevation
looking at the rhythm
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
FINDING THE HEART RATE
  • 3 METHODS
  • RATE RULER
  • COUNTING
  • BOX METHOD
lets summarize
LETS SUMMARIZE

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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