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.
QUICK REVIEW OF HEART Purpose • Pumps blood Basic Anatomy • 4 chambers • 2 sides • 4 valves
THE CONDUCTINGY SYSTEM • SA Node • Inter-nodal pathway • AV Node • Bundle of HIS • Bundle Branches • Purkinje Fibers
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 • 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 • Proper skin prep • Placement of the limb electrodes • Placement of the chest electrodes
SKIN PREPARATION • REASON FOR SKIN PREPARATION • 5 STEP METHOD • 2 STEP METHOD
ELECTRODE PLACEMENT • LIMB LEADS • CHEST LEAD
LIMB LEADS • Bipolar leads I II III • Augment leads Avr Avl Avf
6 UNIPOLAR LEADS V1 V2 V3 V4 V5 V6 CHEST LEADS
LETS REVIEW • What is an ECG • What are the limb leads? • What are the chest leads? • Why do skin prep?
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 • 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
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 • Avr is always negative • Lead I is always positive • Lead II and III positive for the P wave and usually the QRS complex
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 • Artifact • Electrical interference • Somatic tremor • Wandering baseline
BASIC CRITICAL VALUES • Bradycardia – HR < 40bpm • Tachycardia HR > 120bpm • PVC’s - 4 or more in a row • ST Elevation
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 • 3 METHODS • RATE RULER • COUNTING • BOX METHOD
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