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.
2

QUICK REVIEW OF
HEART
Purpose
Pumps blood
Basic Anatomy
4 chambers
2 sides
4 valves
3

THE CONDUCTINGY
SYSTEM
SA Node
Inter-nodal
pathway
AV Node
Bundle of HIS
Bundle Branches
Purkinje Fibers
4

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
7

Principles of
Electrocardiograph
Electrocardiograph is the
instrument that records the
electrical activity of the heart
Electrocardiogram (ECG) is the
record of that activity
8

HOOKING UP THE
12-LEAD ECG
Proper skin prep
Placement of the limb
electrodes
Placement of the chest
electrodes
9

SKIN PREPARATION
REASON FOR SKIN
PREPARATION
5 STEP METHOD
2 STEP METHOD
10

ELECTRODE
PLACEMENT

LIMB LEADS
CHEST LEAD

11

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

12

CHEST LEADS
6 UNIPOLAR
LEADS
V1
V2
V3
V4
V5
V6
13

LETS REVIEW

What is an ECG
What are the limb leads?
What are the chest leads?
Why do skin prep?

14

12-LEAD ECG LAYOUT

15

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

17

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
20

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

35

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

37

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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