MAKING ECGS EASY APPLICATION FOR THE ECG EVALUATING

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. 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 5

CARDIAC CYCLES 6

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 • V 1 • V 2 • V 3 • V 4 • V 5 • V 6 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 16

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 18

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 19

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 COLUMN III • R wave progression • Small to Tall COLUMN IV • R wave progression • Tall to Small 21

LIMB LEADS 22

CHEST LEADS 23

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OTHER PROBLEMS WITH THE ECG • Artifact • Electrical interference • Somatic tremor • Wandering baseline 28

EINTHOVENS TRIANGLE 29

ARTIFACT ON THE ECG 30

FIND THE ARTEFACT 31

WANDERIN BASELINE 32

SOMATIC TREMOR 33

ELECTRICAL INTERFERANCE 34

BASIC CRITICAL VALUES • Bradycardia – HR < 40 bpm • Tachycardia HR > 120 bpm • PVC’s - 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. 36

FINDING THE HEART RATE • 3 METHODS • RATE RULER • COUNTING • BOX METHOD 37

BOX METHOD 38

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ECTOPIC BEATS 43

ECTOPIC BEATS 44

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 45