MAKING ECGS 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 CHEST LEADS
Normal 12-lead COLUMN III
AVR always R wave progression
negative Small to Tall
Lead I always
positive COLUMN IV
Lead II, III R wave progression
positive or Tall to Small
biphasic

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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
PVCs - 4 or more in a row
ST Elevation

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LOOKING AT THE
RHYTHM
Evaluate the Is the rhythm
rhythm strip at regular or
the bottom of irregular?
the 12-lead for Is there a P
the following 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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