Transcript The 15-Lead ECG

10
chapter
The 15-Lead ECG
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
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Chapter 10 Objectives
• Describe the benefits of acquiring a 15-lead
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ECG
Describe the proper lead placement for Leads
V4R, V8, and V9
Describe the hemodynamic problems
associated with a right ventricular infarction
List 3 clinical signs of RVI
On a 15-lead ECG, recognize ECG changes
for a posterior and right ventricular MI
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
109
Why a 15-Lead ECG?
• 12-lead alone misses 50% of the AMIs
• 15-lead ECG increases sensitivity by 23%
• 23 more out of 100 could be diagnosed
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
110
Acquiring the 15-Lead (V4R)
• Run standard 12-lead
• Lead V4R: 5th IC
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space midclavicular
on right side
Same as left side V4
Attach V4 wire to the
V4R position
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Acquiring a 15-Lead (V8, V9)
• Posterior leads
• V8: 5th IC space
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midscapular line
V9 goes between V8
and the spine
Place Lead V5 wire on
V8 and V6 wire on V9
Acquire the second 12lead
Re-label the new leads
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Right Ventricular Infarction
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RV gets blood supply from the RCA
Up to 50% of inferior MI will have RVI
Preload problems
Use nitrates with extreme caution
Fluid bolus of perhaps 1 liter or more is
indicated
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Clinical Signs of RVI
• Jugular vein distention (JVD)
• Hypotension, either presenting or
following nitro administration
• Clear lung sounds
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
111
15-Lead ECG
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Practice Cases
Using the 15-Lead
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
112
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
113
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
114
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
115
Page, 12-Lead ECG for Acute and Critical Care Providers
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ