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.
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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 < 40bpm
Tachycardia HR > 120bpm
PVC’s - 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
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