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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
• 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
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
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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25
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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 < 40bpm
Tachycardia HR > 120bpm
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
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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