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ECG Workshop Dr Jeremy Wright Cardiologist Hearts1st, Greenslopes Private Hospital Topics To Cover Skin preparation Electrode Placement Troubleshooting – Minimise Noise / Artifact Limb Lead Reversal ECG Examples Skin Preparation Important to have good contact between the skin and electrodes Minimises artifact and electrode movement Things to use: - Razors / part hair to expose skin - Preparation tape - Alcohol wipes Electrode Placement LA = Left Arm RA = Right Arm LL = Left Leg RL = Right Leg (ground) Electrode Placement V1: 4th intercostal space, R sternal border V2: 4th intercostal space, L sternal border V3: between V3 and V4 V4: 5th intercostal space, Mid Clavicular line V5: horizontally in line with V4, Anterior Auxillary line V6: horizontally in line with V4, Mid Auxillary line Noise / Artifact Bed Artifact Limb Lead Reversal Most common mistake made when acquiring ECG’s. Be sure to check all leads (especially limb leads) before acquiring the ECG. Limb Lead Reversal Alternate Limb Lead Placement How do you perform an ECG in the following situations? - Amputee Theatre Stockings Patient with Parkinson's Disease / Tremors Normal ECG Waveforms A: Ventricular Ectopy A: 2nd Degree AV Block; Type II A: Complete Heart Block A: Sinus Rhythm with frequent atrial ectopy A: Atrial Fibrillation A: Idioventricular Rhythm A: Acute Anterior MI A: Junctional Rhythm A: Supraventricular Tachycardia A: Ventricular Tachycardia (VT) A: Ventricular Fibrillation (VF)