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chapter

10

The 15-Lead ECG

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Chapter 10 Objectives
Describe the benefits of acquiring a 15-lead
ECG Describe the proper lead placement for Leads V4R, V8, and V9 Describe the hemodynamic problems associated with a right ventricular infarction List 3 clinical signs of RVI On a 15-lead ECG, recognize ECG changes for a posterior and right ventricular MI

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Why a 15-Lead ECG?


12-lead alone misses 50% of the AMIs 15-lead ECG increases sensitivity by 23% 23 more out of 100 could be diagnosed

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Acquiring the 15-Lead (V4R)


Run standard 12-lead Lead V4R: 5th IC

space midclavicular on right side Same as left side V4 Attach V4 wire to the V4R position

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Acquiring a 15-Lead (V8, V9)


Posterior leads V8: 5th IC space
midscapular line V9 goes between V8 and the spine Place Lead V5 wire on V8 and V6 wire on V9 Acquire the second 12lead Re-label the new leads

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Right Ventricular Infarction



RV gets blood supply from the RCA Up to 50% of inferior MI will have RVI Preload problems Use nitrates with extreme caution Fluid bolus of perhaps 1 liter or more is indicated

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Clinical Signs of RVI


Jugular vein distention (JVD) Hypotension, either presenting or
following nitro administration Clear lung sounds

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15-Lead ECG

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Practice Cases
Using the 15-Lead

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ