A GOOD 12 LEAD ECG

K.PADMANABHAN MADRAS MEDICAL MISSION

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WHAT IS ECG?
The heart conduction system of electrical impulse produces currents that radiates through the surrounding tissue to the skin. When electrodes are attached to the skin, they sense those electrical currents and transmit them to an electrocardiograph monitor. The currents are then transformed into waveforms that represent the heart`s depolarization - repolarization cycle.

WHY 12 LEAD ECG ?

A 12 Lead ECG records information from 12
different views of the heart and provides a

complete picture of electrical activity.

DIFFERENT LEADS PROVIDE DIFFERENT INFORMATION

THE COMPONENTS OF ECG

WHAT ARE THE CLINICAL USE OF ECG

To assess the cardiac functions eg, rate, rhythm, and conduction. To diagnose cardiac rhythm disorders eg, heart block To diagnose cardiac diseases eg, myocardial infarction To detect electrolyte imbalance eg, hyperkalaemia To evaluate effects of treatments eg, administration of cardiac drugs.

ECG MACHINE

KNOWLEDGE OF ECG MACHINE

OPERATING TECHINQUE GAINING ADJUSTMENTS

TEMPARATURE SETTINGS (STYLUS)

STYLUS RECORDING SHOULD BE CRISP

AND FINE (CENTRAL PLACEMENT)

NICE RECORD

BASIC SETTINGS FOR GOOD ECG MACHINE

(1) TO KEEP ALWAYS PAPER SPEED (25MM/SEC) FAST RATE; DOUBLE SPEED ( 50MM/SEC) (2) TO KEEP ALWAYS STANDARDIZATION(10mm/mv) TO AVOID OVER STANDADIZATION & UNDER STANDADIZATION PURPOSE OF 5MM & 20MM STANDARDIZATION

(3) TO KEEP ALWAYS BATTERY CHARGING POSITION

TO AVOID AC INTERFERENCE (4) TO KEEP ALWAYS BULB ELECTRODES CLEANLY

KNOWLEDGE OF ECG LEADS

PLACEMENT

LIMB LEAD PLACEMENT

LEAD-1 LEAD-11 LEAD-111 AVR AVL AVF

CHEST LEADS AND EXTRA LEADS PLACEMENTS

V1 V2 V3 V4 V5 V6 V3R & V4R V7 & V8

RIGHT SIDE LEADS

The usual 12-lead ECG evaluates only the left ventricle. If the RV needs to be assessed for damage or dysfunction. Eg.Inferior wall MI - RV lead to rule out the RV involvement

POSTERIOR LEAD ECG

These ECG`s used to assess the posterior side of the heart, standared 12 lead ECG`s can`t assess(posterior surface of myocardium). V7, V8, V9, These leads are placed opposite of the anterior leads V4,V5, AND V6 on the left side of the patient back following the same horizontal line.

WHERE THE ECG LEADS WIRES SHOULD GO

Where to place the electrodes on the patient is easy because each lead wire is labeled or colour coded, according to which wire corresponds to which lead. If they are placed too low, the ECG tracing will be inaccurate.

PREPARING FOR THE RECORDING

First gather all the necessary supplies including the 1. ECG Machine

2. Recording paper 3. Electrodes 4. ECG Jelly 5. Gauze pads.

Take them to the patient bedside.

EXPLAIN THE PROCEDURE

Tell the patient (If stable)
1.The doctor advised to take ECG 2.Explain about test,duration and purpose

3. First prepare the mentally & physically

PATIENT COMFORTABLE COT

4. Ask the patient to lie supine position
5.Arms and his legs are relax position 6.If he can`t tolerate to lying flat, raise the head of the bed to semi flower`s position. 7. Ensure privacy and expose the patient`s arms, legs and chest, draping him comfort.

ELECTRODES
Explain The Electrode Placement Procedure The Electrodes Must Be Applied Correctly.

Expose The Patient`s Chest And Select Electrode Sites .

Choose Sites Over Soft Tissues Or Close To Bone Not Over Thick Muscles Or Skin Folds, Those Areas Can Produce ECG Artifacts.

ELECTRODES

PREPARE THE PATIENT

-APPLY ECG JELLY
-CONNECT THE ECG CABLE GENTLEY -ONCE AGAIN CHECK THE LEADS PROPERLY

BEFORE START OF ECG RECORDING

TELL TO BREATHE CALMLY ( IF STABLE)
TELL THE PATIENT NOT TO MOVE TELL TO AVOID TALKING DURING ECG TELL TO RELAX (To avoid muscle tremor)

BEFORE START OF ECG RECORING

IF SHIVERING (PROVIDE COVERING SHEET) TREAT AND TAKE AFTER SETTLING FEMALES PATIENT- FEMALE ATTANDANT AND PRIVACY MUST. (NO ONE SHOULD NOT BE ALLOWED WHEN FEMALE PATIENT ECG UNLESS PATIENT SERIOUS).

DURING ECG RECORDING

DO NOT BE MISERLY ATLEAST TAKE 2-3 BEATS IN EACH LEAD

LONG LEAD II AND V1 SHOULD BE

AT LEAST FOR 20 COMPLEXES IN

TACHYCARDIAS

DURING ECG RECORDING

ALWAYS TAKE ECG PROMPTLY WHEN PATIENT HAS CHEST PAIN

SHOULD CHECK FOR ST ELEVATION OR DEPRESSION

INFORM PYHSICIAN IMMEDIATELY

DONOT LEAVE ALONE UNSTABLE PATIENTS WITHOUT ATTENDED

AFTER ECG TRACING

- OBSERVE THE QUALITY OF
TRACING REMOVE THE ELECTRODES & CLEAN TELL HIM ONCE TEST IS OVER

ALWAYS WIPE THE JELLY YOURSELF

DESPATCH THE REPORT ASK HIM TAKE PHOTOCOPY FOR FUTURE REFERENCE

HOW TO DESPATCH ECG REPORT

PATIENT NAME AGE SEX DATE TIME REFERED DOCTOR NAME TECHNICIAN NAME PASTE THE ECG GENTLEY

GOOD NORMAL ECG

TROUBLESHOOTING PROBLEMS

TROUBLESHOOTING PROBLEMS
ARTIFACT (WAVEFORM INTERFERENCE)
INTERFERENCE WANDERING BASELINE FAULTY EQUIPMENT

PATIENT MOVEMENT

PATIENT MOVEMENT
CAUSE :
PATIENT TURNING IN BED OR EXTREMITY MOVEMENT.

SOLUTION:
PROBLEM IS USUALLY INTERMITTENT AND NO CORRECTIONIS NECESSARY. MOVEMENT ARTIFACT CAN BE REDUCED BY AVOIDING PLACEMENT OF ELECTRODE IN AREAS WHERE EXTREMITY MOVEMENT IS GREATEST. (BONY AREAS SUCH AS THE CLAVICLES).

CONTINUOUS MUSCLE TREMOR

INTERMITTENT MUSCLE TREMOR

CONTINUOUS MUSCLE TREMOR

CAUSES
MUSCLE TREMORS ARE USUALLY RELATED T0 TENSE NERVOUS PATIENTS THOSE SHIVERING FROM COLD OR A CHIL TIGHT ELECTRODE STRAPS LOOSE ELECTRODES OR FALULTY CABLES

SOLUTION :
TREAT CAUSE

TIGHTNING OF STYLUS

WANDERING BASELINE ECG

WANDERING BASELINE
CAUSES:
EXAGGERATED RESPIRATORY MOVEMENTS USUALLY SEEN IN PATIENTS IN RESPIRATORY DISTRESS .

SOLUTION:
AVOID PLACING ELECTRODE IN AREAS WHERE MOVEMENTS OF THE ACCESSORY MUSCLES ARE MOST EXAGGERATED . PLACE THE ELECTRODES ON THE TOP OF THE SHOULDERS.

ELECTRICAL INTERFERENCE

ELECTRICAL INTERFERENCE
CAUSES:

PATIENT USING ELECTRICAL EQUIPMENT IMPROPERLY GROUNDED EQUIPMENT LOOSE ELECTRICAL CONNECTIONS OR EXPOSED WIRING.

SOLUTIONS:
(A) IF PATIENT IS USING ELECTRICAL EQUIPMENT, TO PUT OFF THE EQUIPMENT. PROBLEM IS TRANSIENT AND WILL CORRECT ITSELF. (B) IF PATIENT IS NOT USING ELECTRICAL EQUIPMENT
(1) UNPLUG ALL EQUIPMENT NOT IN CONTINOUS USE (2) REMOVE FROM SERVICE AND USE BATTERY CONNECTION (3) ASK THE ELECTRICAL ENGINEER TO CHECK THE WIRING.

HIGH TEMPRATURE

REMEMBER
ELECTRONIC MACHINES NOT TO RELY FULLY ON THE MACHINE DIAGNOISIS BETTER TO INTERPRET IT PERSONALLY

REMEMBER
ALWAYS READ SOME TEXTBOOK ON ECG
TRY TO INTERPRET THE ECG YOURSELF START WITH SOME EASY TEXTBOOKS

YOU SHOULD KNOW WHAT YOU ARE DOING

REMEMBER
INTERPRET THE RECORDING

TAKE ACTIVE INTEREST IN ARRHYTHMIA DIAGNOSIS AND CLINICAL CORRELATION KNOWLEDGE CAN BE A GREAT ASSET

REMEMBER
YOU MAY BE THE FIRST PERSON TO
DETECT A DANGEROUS ARRHYTHMIA OR ACUTE MI!

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