MAKING ECG

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MAKING ECGS EASY

• APPLICATION FOR THE ECG
• EVALUATING THE ECG

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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

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RELATIONSHIP
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CARDIAC CYCLES
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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

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HOOKING UP THE 12-LEAD ECG

• Proper skin prep
• Placement of the limb electrodes
• Placement of the chest electrodes

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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 lt 40bpm
• Tachycardia HR gt 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