MAKING ECGS 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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QUICK REVIEW OF HEART

Purpose Pumps blood
Basic Anatomy 4 chambers 2 sides 4 valves
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THE CONDUCTINGY SYSTEM

SA Node Inter-nodal pathway AV Node Bundle of HIS Bundle Branches Purkinje Fibers

RELATIONSHIP

CARDIAC CYCLES

12 LEAD ECG
Learning objectives:

Describe the correct placement of all electrodes Proper Skin preparation Care of the ECG machine, wires and electrodes
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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

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ELECTRODE PLACEMENT

LIMB LEADS CHEST LEAD

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LIMB LEADS
Bipolar leads I II III Augment leads Avr Avl Avf

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CHEST LEADS
6 UNIPOLAR LEADS V1 V2 V3 V4 V5 V6
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LETS REVIEW
What is an ECG What are the limb leads? What are the chest leads? Why do skin prep?

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12-LEAD ECG LAYOUT

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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
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INFORMATION ON THE 12-LEAD ECG

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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
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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

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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
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CHEST LEADS
CHEST LEADS COLUMN III R wave progression Small to Tall
COLUMN IV R wave progression Tall to Small

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LIMB LEADS

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CHEST LEADS

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OTHER PROBLEMS WITH THE ECG

Artifact Electrical interference Somatic tremor Wandering baseline

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EINTHOVENS TRIANGLE

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ARTIFACT ON THE ECG

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FIND THE ARTEFACT

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WANDERIN BASELINE

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SOMATIC TREMOR

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ELECTRICAL INTERFERANCE

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BASIC CRITICAL VALUES

Bradycardia HR < 40bpm Tachycardia HR > 120bpm PVCs - 4 or more in a row ST Elevation

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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.
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FINDING THE HEART RATE

3 METHODS
RATE RULER COUNTING BOX METHOD

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BOX METHOD

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ECTOPIC BEATS

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ECTOPIC BEATS

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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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