Transcript ECG TRAINING MODULE 2

ECG TRAINING MODULE 2
BY
BRAD CHAPMAN RCT
OBJECTIVES
1.
2.
3.
4.
PATIENT APPROACH
LEAD PLACEMENT
ARTIFACT
SPECIAL NEEDS PATIENTS
The Approach
Enter to the left hand side of the patient
 Ensure them that this test doesn't hurt
 Make sure curtain is pulled across for the
women
 Ask the Men if they want the curtain pulled
– most won't but occasional one will
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Patient Preparation
Tell patient that you are going to place
stickers on them and then connect some
wires
 Start by placing a sticker on either the
arms or legs first – this helps to show that
this test is non-invasive and helps to
relieve anxiety
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Placement of Leads
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Find the first intercoastal space by moving a
finger down the right collar bone towards the
sternum. Stop a ½ “ before the sternum
Rock fingers down chest counting the intercostal
spaces
Count down to the 4th intercostal space
Place a sticker there
Repeat process on the other side of the sternum
Placement of leads

Draw a vertical line from mid-clavicular to
under the breast and place a sticker. This will
be V4.
 Place sticker in between v2 and v4
This
sticker would be on a diagonal plane
between v2 and v4
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Visual drop a horizontal line straight line
down from v4 to mid-auxilla and place a
sticker (v6)
Place a sticker between v4 and v6 – this will
be your v5 lead
Chest Lead Placement
All chest leads are labelled v1, v2, v3,...v6.
 All leads are color coded.
 Chest leads are
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Red
 Yellow
 Green
 Blue
 Orange
 Purple
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Easy to remember
Stop Light
 Red, Yellow, Green
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BOP
 Blue, Orange, Purple
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Artifact
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There are different types of artifact
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Somatic tremors (muscle artifact) – most
common
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Wandering baseline
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AC interference
Somatic Tremors (Muscle artifact)
CAUSE
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Most common type of artifact
Caused by patient moving limbs, fingers, nervous, restless, or
anxious
REMEDY
Try to have the patient relax and hold still
 Try talking in a calming
voice while doing the tracing
 Move limb stickers higher
up the limb

Wandering Baseline
CAUSE
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Patient is moving or stickers are not making a good
contact
Cables may be dangling or swaying
REMEDY
Place a towel on chest leads
to weight them down
 Apply pressure to lead
with a towel
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AC Interference

Consistent and regular saw tooth pattern
REMEDY
Turn off all cell phones and other electronic devices
(possibly lights)
 Unplug electric bed
 TENS machines must
be turned off to do ECG
 Place ECG machine further
away from ventilators, IV pumps
 X-Ray equipment
 Radio and TV

Where is that Artifact coming from?
If there is artifact in
these leads
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Check this connection
Lead I and II
Lead I and III
Lead II and III
RA
LA
LL
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OR
Tap on or shake the limb lead and see where the
interference is coming from
Special Needs Patient
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Amputees
Burns
Tremors
Paediatrics
Wheelchair
Trauma
SOB
Acute MI
Psychiatric
AMPUTEES
Place lead further up the limb or even on
the hip or shoulder
 You can put both leg leads on the left leg
as long as the left lead is higher up the leg
then the right leg lead
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BURNS
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Place leads on parts of the skin that are not burnt
Do not remove any clothing that is stuck to the skin
Take alligator clip off the end of the lead, clean with alcohol and hold
the tip of the lead on the skin lightly
TREMORS
Parkinson’s disease
 Place hands underneath the buttocks
 Place electrodes on Hips or Shoulders
 Add extra pillow under knees
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PEDIATRICS
Getting small children to hold still during an
ECG may be challenging
 Distraction with toys or Music
 Young infants, place stickers on then wrap in a
blanket
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WHEELCHAIR
Assist to transfer to bed
 If they can’t move to bed – do ECG in the
chair
 Record on the ECG that done while sitting
up. (Changes the axis of the heart)
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TRAUMA
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Remain calm – work at putting on stickers while the
medical team does their task
Place your stickers on and hook up wires
Communicate to the trauma team when you are ready to
acquire the tracing
When ready tell the trauma team not to move them for
10 seconds
RESPIRATORY DISTRESS
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The patient in respiratory distress is difficult to
obtain an ECG on
You may have to have them in sitting position –
just remember to record a comment on the ECG
Place limb leads higher up (Shoulders & Hips)
CHEST TUBES
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Place all electrodes you can without moving
bandages
You will probably have to leave leads V5 and V6
off
Take extra precautions around the chest tube.
Seek help if it appears to be loose.
ACUTE MYOCARDIAL
INFARCTION
Remain calm
 Leave stickers on if you will be doing
serials ECG’s. This will accurately
measure changes due to MI and not
movement
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PSYCHIATRIC
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Be very reassuring when it comes to explaining the
exam
Explain the test in layman terms
Never use the word “electro”
Always call an ECG a “Cardiogram” or Heart Tracing
ECG sounds like ECT (shock therapy)
REVIEW QUIZ!
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Thank you for your time.