Welcome To NTT eM eT eae 1) For NCLEX , HAAD, MOH, CEE ya pee LIPLn) (5pm-6pm) PH8281002707EKG 12 Lead Electrode Placement | RA, RL, LA, LL, V1, V2, V3, V4, V5 & V6 ‘Supplies you will need +10 Electrode Stickers +1 strip of abrasive tape (this roughs up the epidermis so you can get a good connection) *Alcohol prep pads (cleans the skin's oils so you can get a good connection) Prep the Skin + First clean the electrode site placements with alcohol prep to remove oils and dirt from the skin. Then gently “rough up’ the area with the abrasive tape so the electrodes will stick properly + Tip: Always make sure your electrodes are not expired or the gel is dry because this can affect the connection In addition, never place an electrode over an implanted device in the skinEKG 12 Lead Placement There are a total of 10 leads (4 limb leads & 6 chest/precordial leads) and they are the following: sight arm (RA) sLeft arm (LA sRight leg (RL) Left leg (LL) “I v2, “3 v4 V5 V6 Location of EKG 12 Lead Placement *RA: Placed on the right arm or right below the right clavicle LA: Placed on the left arm or right below the left clavicle RL: Placed on the right leg or upper right quadrant “LL: Placed on the left leg or upper left quadrant *V1: Placed in the fourth intercostal space to the right of the sternum V2: Placed in the fourth intercostal space to the left of the sternum +V3: Placed directly between leads V2 and V4 *V4; Placed in the fifth intercostal space in the mid-clavicular line *V5: Placed level with V4 at the left anterior mid-axillary line *V6; Placed level with V5 at the mid-axillary Ag ""oAA0eN naa ws% P-wave: The first little "hump" or "bump! you see is known as the P-wave. P-wave represents ATRIAL DEPOLARIZATION Rome. (depolarization is a big, fancy word for CONTRACTION) “Fuowe v wo QRS Complex: The next area a big spike. This spike is called the QRS complex. The bundle of His, bundle Q branches, and Purkinje fibers are responsible for this. S The QRS complex represent VENTRICLE DEPOLARIZATION (contractions of the ventricles) T-wave: After this spike, you will see a "bump" shortly after the complex. This "bump' is called the t- wave and is caused by the ventricles relaxing, The ventricles are so large that when they contract, (depolarize) the form a large electrical impulse that presents the QRS complex. Therefore, (because they are 50 large) when they relax (repolarize) they form a small electrical impulse that presents as the t-wave. U-wave: This is not very common, but | wanted to show it to you and mention it. The u-wave sometimes is seen after the t-wave. This is thought to be caused by the relaxation of the Purkinje fibersPR Interval & ST Segment: PR -interval: As noted on the diagram above, the PR- interval starts at atrial contraction (remember atrial ST SEGMENT contraction is represented by the P-wave) and ends at the beginning of ventricle depolarization. So in other words, it starts at the P-wave and ends at the beginning of the QRS. complex. INTERVAL ST segment: This segment starts at the J-point. The J- et iF point is where you start to see an upward stroke after the aaa 'S wave. The segment ends at the beginning of the T-wave. The ST-segment represents when the ventricles are relaxing, also called repolarizing.Rule of 6 seconds “Jor bath eoular & Inegulor thythms”” 7 Number of ORS complexes in 6 seconds (30 large squares ) X10 Number of QRS complexes in 10 seconds (50 Large squares) X 6 @oeoooo 0 @ ahhh hhh 77QRS complexes in seconds ssheartrate 70 beats/min How to Count Atrial and Ventricular Rate using the 6 Second Rule Atrial Rate 1uldentify the p-waves 2.Beginning at the first p-wave start counting 30 large squares. 3.Then count how many p-waves are between the 30 large squares 4.Take that number and multiple it by 10 and this is your heart rate. Important things to note about the squares: Each large block contains 25 squares *Each small square represents 0.04 seconds of time +5 small squares equal 0.20 seconds of time +When you are trying to calculate the heart rate with the six second rule, you must count out enough LARGE squares to equal 6 seconds, Therefore, 30 large squares would equal 6 seconds. Ventricular Rate 1L.identify the r-waves 2.Beginning at the first r-wave start counting 30 large squares. 3.Then count how many r-waves are between the 30. large squares. 4qTake that number and multiple it by 10 and this is your heart rate,15 Degree AV Heart Block 1st Degree Heart Block Ne ‘A normal PR interval is 0.12-0.20 and here the PR interval is greater than 0.20, +Regular P-waves and R-waves “P-wave always accompanying the QRS complex *QRS complex will measure normal “PR INTERVAL WILL BE PROLONGED2N? Degree Type 1 | Wenckebach | Mobitz | 2nd Degree Type 1 Heart s & PR interval are progressively lengthening and then all of a sudden a QRS complex is missing This rhythm is CYCLIC and will always present with progressively lengthen PR intervals until a QRS complex disappears and then it will repeat itself. You will also have the following with this rhythm: *P-waves & R-wave will be IRREGULAR “PR intervals ABNORMAL “Missing QRS complex “CYCLIC24 Degree Type 2 | Mobitz I! 2nd Degree Type 2 Heart Block “ P-waves will be regular, however R-waves will NOT “PR interval will measure normal (most of the time) NO Pattern “Missing QRS Complexes after p-waves randomly3" Degree Heart Block (Complete Heart Block) Third Degree Heart Block waves will be Regular AND R-waves will be Regular P-wave will not accompany QRS complexes and vice versus, hence no relationship between the atriums and ventricles You can’t measure a PR interval because the atriums and ventricles are independentThe Heart Block Poem by the Princeton Surgical Group & nyjrsesi If the R is far from P, et, me then you have a FIRST DEGREE 2 Be Foal Longer, longer, longer, drop! ae a aie Then you have a WENKEBACH. IfsomePsdon'tget through, ~ eff > eff] then you have MOBITZ II. te If Ps and Qs don't agree, a then youhave aTHIRD DEGREE. ||, [- > fires» | OFT RSA ENO Teo? 1