Introduction to 12 Lead Interpretation
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Transcript Introduction to 12 Lead Interpretation
ONTARIO
BASE HOSPITAL GROUP
Chapter 6
for 12 Lead Training
-Introduction to 12 Lead InterpretationOntario Base Hospital Group
Education Subcommittee
2008
TIME IS
MUSCLE
Introduction to 12 Lead
Interpretation
AUTHOR
REVIEWERS/CONTRIBUTORS
Greg Soto, BEd, BA, ACP
Neil Freckleton, AEMCA, ACP
Hamilton Base Hospital
Niagara Base Hospital
Jim Scott, AEMCA, PCP
Sault Area Hospital
Ed Ouston, AEMCA, ACP
Ottawa Base Hospital
Laura McCleary, AEMCA, ACP
SOCPC
Tim Dodd, AEMCA, ACP
Hamilton Base Hospital
2008 Ontario Base Hospital Group
Dr. Rick Verbeek, Medical Director
SOCPC
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Chapter 6 - Objectives
Recognize
the usefulness of ECG data provided
by computerized 12 Lead ECG
Identify important features of ECG such as Q, R,
S, T waves and relate to 12 Lead interpretation
Find J-points and compare to TP segments
Recognize ST-elevation and relate to clinical
significance
Become comfortable with recognizing and
locating AMI on 12 Lead ECG
Practice a bit of 12 Lead interpretation
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12 Lead Interpretation
Interpretation
vs. STEMI Recognition
It is important to note that upon
completion of this training, it is not
expected that paramedics will be
“interpreting” a 12 Lead but rather
recognizing STEMI patients
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Learning 12 Lead ECG
Interpretation
Common Paramedic responses prior to
learning 12 Lead ECG Interpretation:
I can’t interpret a 12 Lead ECG like a
Cardiologist!
Are you kidding me?
Common Paramedic responses after learning
12 Lead ECG Interpretation:
Hey – that wasn’t as hard as I thought it
would be!
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Essential Interpretation
Goals
Recognize
and localize
AMI on the ECG
Feel comfortable with 12
Lead interpretation
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12 Lead ECG
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12 Lead ECG
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12 Lead ECG
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R Wave
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Q Wave
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S Wave
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J-Point
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ST Segment
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The J Point
J
point - end of QRS complex &
beginning of ST segment
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Practice
Find
J-points and ST segments
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Practice
Find
J-points and ST segments
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12-Lead ECG
AMI
recognition
Two
things to know
What
to look for
Where to look
Local medical oversight will determine the criteria used
to identify a STEMI patient. All stakeholders must be
consulted to determine what criteria should be utilized
in a given centre.
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What to look for
Example
- ST segment elevation
One
millimetre or more (one small
box) in limb leads
Two millimetres or more (two small
boxes) in chest leads
Present in two anatomically
contiguous leads
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Contiguous Leads
Limb
leads that “look” at the same area
of the heart
OR
Numerically
consecutive chest leads
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Contiguous Leads
Inferior
wall: II, III, avF
Lateral wall: I, aVL, V5, V6
Septum: V1 and V2
Anterior wall: V3 and V4
Posterior
wall: V7, V8, V9
(leads placed on the patient’s back 5th
intercostal space creating a 15 lead EKG)
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Where to look
ST
segment elevation measurement
0.04 seconds after J point
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ST Segment Elevation
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ST Segment Elevation
Presumptive
evidence
of AMI
Indication
for acute
reperfusion therapy
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ST Segment
Compare
to TP segment
ST
TP
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ST Segment Analysis
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Practice
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Lead “Views”
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Lead Groups
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Limb Leads
Chest Leads
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Lead “Views”
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Inferior Wall
II,
III, aVF
Left Leg
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Inferior Wall
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Inferior Wall
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Lateral Wall
I
and aVL
Left
Arm
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Lateral Wall
V5
and V6
Left lateral chest
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Lateral
I,
aVL, V5, V6
Lateral Wall
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Anterior Wall
V3,
V4
Left anterior chest
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Anterior Wall
• V3, V4
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Septal Wall
V1,
V2
Along sternal borders
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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Septal
• V1,V2
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
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AMI Localization
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Anterior:
Septal:
Inferior:
Lateral:
V3, V4
V1, V2
II, III, AVF
I, AVL, V5, V6
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AMI Recognition
I Lateral
aVR
II Inferior
aVL Lateral
III Inferior
aVF Inferior
V1 Septal
V4 Anterior
V2 Septal
V5 Lateral
V3 Anterior
V6 Lateral
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AMI Recognition
Know
what to look for
ST elevation
> 1mm in limb leads
> 2mm chest leads
Two contiguous leads
Know
where you are looking
You will soon have this memorized
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Mnemonic for Location
Rhyme,
phrase or device for remembering
something
“LII – LI – ASS (backwards) – ALL”
L = I (Lateral)
I = II (Inferior)
I = III (Inferior)
L = aVL (Lateral)
I = aVF (Inferior)
S = V1 (Septal)
S = V2 (Septal)
A = V3 (Anterior)
A = V4 (Anterior)
L = V5 (Lateral)
L = V6 (Lateral)
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Using mnemonic on ECG
You
may want to write the Letters in the
corner of each Lead when interpreting
L
S
A
I
L
S
L
I
I
A
L
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Antero Septal
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Extensive Anterior
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Inferior
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Extensive Anterior
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Inferior
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Extensive Anterior
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Normal ECG
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Inferior
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Infero-lateral
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Inferior
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Inverted T-waves = ischemia
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ONTARIO
BASE HOSPITAL GROUP
QUESTIONS?
ONTARIO
BASE HOSPITAL GROUP
Well Done!
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