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A GOOD 12 LEAD ECG. K.PADMANABHAN MADRAS MEDICAL MISSION. www.anaesthesia.co.in [email protected] WHAT IS ECG?.

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A good 12 lead ecg

A GOOD 12 LEAD ECG

K.PADMANABHAN

MADRAS MEDICAL MISSION

www.anaesthesia.co.in

[email protected]


What is ecg
WHAT IS ECG?

  • The heart conduction system of electrical impulse produces currents that radiates through the surrounding tissue to the skin. When electrodes are attached to the skin, they sense those electrical currents and transmit them to an electrocardiograph monitor.

  • The currents are then transformed into waveforms that represent the heart`s depolarization - repolarization cycle.


Why 12 lead ecg
WHY 12 LEAD ECG ?

  • A 12 Lead ECG records information from 12 different views of the heart and provides a complete picture of electrical activity. DIFFERENT LEADS PROVIDE DIFFERENT INFORMATION



What are the clinical use of ecg
WHAT ARE THE CLINICAL USE OF ECG

  • To assess the cardiac functions

    eg, rate, rhythm, and conduction.

  • To diagnose cardiac rhythm disorders

    eg, heart block

  • To diagnose cardiac diseases

    eg, myocardial infarction

  • To detect electrolyte imbalance

    eg, hyperkalaemia

  • To evaluate effects of treatments

    eg, administration of cardiac drugs.



Knowledge of ecg machine
KNOWLEDGE OF ECG MACHINE

  • OPERATING TECHINQUE

  • GAINING ADJUSTMENTS

  • TEMPARATURE SETTINGS (STYLUS)

  • STYLUS RECORDING SHOULD BE CRISP AND FINE (CENTRAL PLACEMENT)

  • NICE RECORD


Basic settings for good ecg machine
BASIC SETTINGS FOR GOOD ECG MACHINE

(1) TO KEEP ALWAYS PAPER SPEED (25MM/SEC) FAST RATE; DOUBLE SPEED ( 50MM/SEC)

(2) TO KEEP ALWAYS STANDARDIZATION(10mm/mv)

TO AVOID OVER STANDADIZATION & UNDER STANDADIZATION

PURPOSE OF 5MM & 20MM STANDARDIZATION

(3) TO KEEP ALWAYS BATTERY CHARGING POSITION

TO AVOID AC INTERFERENCE

(4) TO KEEP ALWAYS BULB ELECTRODES CLEANLY



Limb lead placement
LIMB LEAD PLACEMENT

  • LEAD-1

  • LEAD-11

  • LEAD-111

  • AVR

  • AVL

  • AVF


Chest leads and extra leads placements
CHEST LEADS AND EXTRA LEADS PLACEMENTS

  • V1

  • V2

  • V3

  • V4

  • V5

  • V6

  • V3R & V4R

  • V7 & V8


Right side leads
RIGHT SIDE LEADS

  • The usual 12-lead ECG evaluates only the left ventricle.

  • If the RV needs to be assessed for damage or dysfunction. Eg.Inferior wall MI - RV lead to rule out the RV involvement


Posterior lead ecg
POSTERIOR LEAD ECG

  • These ECG`s used to assess the posterior side of the heart, standared 12 lead ECG`s can`t assess(posterior surface of myocardium).

  • V7, V8, V9, These leads are placed opposite of the anterior leads V4,V5, AND V6 on the left side of the patient back following the same horizontal line.


Where the ecg leads wires should go
WHERE THE ECG LEADS WIRES SHOULD GO

  • Where to place the electrodes on the patient is easy because each lead wire is labeled or colour coded, according to which wire corresponds to which lead.

  • If they are placed too low, the ECG tracing will be inaccurate.


Preparing for the recording
PREPARING FOR THE RECORDING

First gather all the necessary supplies including the

1. ECG Machine

2. Recording paper

3. Electrodes

4. ECG Jelly

5. Gauze pads.

Take them to the patient bedside.


Explain the procedure
EXPLAIN THE PROCEDURE

  • Tell the patient (If stable) 1.The doctor advised to take ECG 2.Explain about test,duration and purpose 3. First prepare the mentally & physically


Patient comfortable cot
PATIENT COMFORTABLE COT

4. Ask the patient to lie supine position

5.Arms and his legs are relax position

6.If he can`t tolerate to lying flat, raise the head of the bed to semi flower`s position.

7. Ensure privacy and expose the patient`s arms, legs and chest, draping him

comfort.


Electrodes
ELECTRODES

  • Explain The Electrode Placement Procedure

  • The Electrodes Must Be Applied Correctly.

  • Expose The Patient`s Chest And Select Electrode Sites .

  • Choose Sites Over Soft Tissues Or Close To Bone Not Over Thick Muscles Or Skin Folds, Those Areas Can Produce ECG Artifacts.



Prepare the patient
PREPARE THE PATIENT

  • -APPLY ECG JELLY

  • -CONNECT THE ECG CABLE GENTLEY

  • -ONCE AGAIN CHECK THE LEADS PROPERLY


Before start of ecg recording
BEFORE START OF ECG RECORDING

  • TELL TO BREATHE CALMLY ( IF STABLE)

  • TELL THE PATIENT NOT TO MOVE

  • TELL TO AVOID TALKING DURING ECG

  • TELL TO RELAX (To avoid muscle tremor)


Before start of ecg recoring
BEFORE START OF ECG RECORING

  • IF SHIVERING (PROVIDE COVERING SHEET)

  • TREAT AND TAKE AFTER SETTLING

  • FEMALES PATIENT- FEMALE ATTANDANT AND PRIVACY MUST.

    (NO ONE SHOULD NOT BE ALLOWED WHEN FEMALE PATIENT ECG UNLESS PATIENT SERIOUS).


During ecg recording
DURING ECG RECORDING

  • DO NOT BE MISERLY

  • ATLEAST TAKE 2-3 BEATS IN EACH LEAD

  • LONG LEAD II AND V1 SHOULD BE

  • AT LEAST FOR 20 COMPLEXES IN TACHYCARDIAS


During ecg recording1
DURING ECG RECORDING

  • ALWAYS TAKE ECG PROMPTLY WHEN PATIENT HAS CHEST PAIN

  • SHOULD CHECK FOR ST ELEVATION OR DEPRESSION

  • INFORM PYHSICIAN IMMEDIATELY

  • DONOT LEAVE ALONE UNSTABLE PATIENTS WITHOUT ATTENDED


After ecg tracing
AFTER ECG TRACING

- OBSERVE THE QUALITY OF TRACING

  • REMOVE THE ELECTRODES & CLEAN

  • TELL HIM ONCE TEST IS OVER

  • ALWAYS WIPE THE JELLY YOURSELF

  • DESPATCH THE REPORT

  • ASK HIM TAKE PHOTOCOPY FOR FUTURE REFERENCE


How to despatch ecg report
HOW TO DESPATCH ECG REPORT

  • PATIENT NAME

  • AGE

  • SEX

  • DATE

  • TIME

  • REFERED DOCTOR NAME

  • TECHNICIAN NAME

  • PASTE THE ECG GENTLEY




Troubleshooting problems1
TROUBLESHOOTING PROBLEMS

  • ARTIFACT (WAVEFORM INTERFERENCE)

  • INTERFERENCE

  • WANDERING BASELINE

  • FAULTY EQUIPMENT



Patient movement1
PATIENT MOVEMENT

  • CAUSE :PATIENT TURNING IN BED OR EXTREMITY MOVEMENT.

  • SOLUTION: PROBLEM IS USUALLY INTERMITTENT AND NO CORRECTIONIS NECESSARY. MOVEMENT ARTIFACT CAN BE REDUCED BY AVOIDING PLACEMENT OF ELECTRODE IN AREAS WHERE EXTREMITY MOVEMENT IS GREATEST. (BONY AREAS SUCH AS THE CLAVICLES).




Continuous muscle tremor1
CONTINUOUS MUSCLE TREMOR

  • CAUSES MUSCLE TREMORS ARE USUALLY RELATED T0 TENSE NERVOUS PATIENTS THOSE SHIVERING FROM COLD OR A CHIL TIGHT ELECTRODE STRAPS LOOSE ELECTRODES OR FALULTY CABLES

  • SOLUTION: TREAT CAUSE




Wandering baseline
WANDERING BASELINE

  • CAUSES: EXAGGERATED RESPIRATORY MOVEMENTS USUALLY SEEN IN PATIENTS IN RESPIRATORY DISTRESS .

  • SOLUTION: AVOID PLACING ELECTRODE IN AREAS WHERE MOVEMENTS OF THE ACCESSORY MUSCLES ARE MOST EXAGGERATED . PLACE THE ELECTRODES ON THE TOP OF THE SHOULDERS.



Electrical interference1
ELECTRICAL INTERFERENCE

  • CAUSES: PATIENT USING ELECTRICAL EQUIPMENT

  • IMPROPERLY GROUNDED EQUIPMENT LOOSE ELECTRICAL CONNECTIONS OR EXPOSED WIRING.

  • SOLUTIONS:

  • (A) IF PATIENT IS USING ELECTRICAL EQUIPMENT, TO PUT OFF THE EQUIPMENT. PROBLEM IS TRANSIENT AND WILL CORRECT ITSELF.

  • (B) IF PATIENT IS NOT USING ELECTRICAL EQUIPMENT (1) UNPLUG ALL EQUIPMENT NOT IN CONTINOUS USE (2) REMOVE FROM SERVICE AND USE BATTERY CONNECTION (3) ASK THE ELECTRICAL ENGINEER TO CHECK THE WIRING.



Remember
REMEMBER

  • ELECTRONIC MACHINES

  • NOT TO RELY FULLY ON THE MACHINE DIAGNOISIS

  • BETTER TO INTERPRET IT PERSONALLY


Remember1
REMEMBER

  • ALWAYS READ SOME TEXTBOOK ON ECG

  • TRY TO INTERPRET THE ECG YOURSELF

  • START WITH SOME EASY TEXTBOOKS

  • YOU SHOULD KNOW WHAT YOU ARE DOING


Remember2
REMEMBER

  • INTERPRET THE RECORDING

  • TAKE ACTIVE INTEREST IN ARRHYTHMIA DIAGNOSIS AND CLINICAL CORRELATION

  • KNOWLEDGE CAN BE A GREAT ASSET


Remember3
REMEMBER

  • YOU MAY BE THE FIRST PERSON TO DETECT A DANGEROUS ARRHYTHMIA OR ACUTE MI!


www.anaesthesia.co.in

[email protected]

THANKING YOU


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