Rapid 12 Lead Acquisition<br />Michael D. Murley<br />
12 Lead Rapid Acquisition<br /><ul><li> Module 1  Electrode Location
 Module 2  Electrode Placement
Module 3  Demonstrations
Module 4  Reducing Artifact
Module 5  Tips and Techniques  </li></li></ul><li>Module 1  Electrode Location<br />Electrodes must be placed in the prope...
Module 1  Electrode Location<br />12 leads obtained from 10 electrodes<br /><ul><li> 4 on the limbs
6 on the chest</li></li></ul><li>Module 1  Electrode Location<br />Limb lead positioning is simple.<br />The electrodes ar...
Module 1  Electrode Location<br />Chest leads have specific anatomic locations<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 1  Electrode Location<br />
Module 2  Electrode Placement<br /><ul><li>The key to correctly placing the chest electrodes is finding the 4th intercosta...
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />Here’s another approach to locating the 4th intercostal space<br />
Module 2  Electrode Placement<br />Best view laterally<br />
Module 2  Electrode Placement<br /><ul><li>Locate the supersternal notch (1) at the top of the manubrium
Palpate down appox 2” until you find the sternal angle, slide your finger laterally to the right, you’re finger is now on ...
Palpate down into the 2nd 3rd and 4th intercostal space</li></ul>1<br />
Module 2  Electrode Placement<br />After placing V2, palpated down to the 5th intercostal space midclavicular line and pla...
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 2  Electrode Placement<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />If you were the patient, where would you prefer to have you’re 12 Lead done, in the house or i...
Module 3Demonstrations<br />There’s a lot of people out there and they can see into the ambulance.  You should obtain the ...
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 3Demonstrations<br />
Module 4  Reducing Artifact<br />Unless you have a clear ECG to analyze, all you interruptive skills are of little use<br />
Module 4  Reducing Artifact<br />Stress labs obtain clear ECG’s while the Patient is running on a treadmill<br />We should...
Module 4  Reducing Artifact<br />As the heart depolarizes, an electrode on the Pt’s skin picks up the electrical activity<...
Module 4  Reducing Artifact<br />It can also pick up other electrical signals<br />
Module 4  Reducing Artifact<br />To reduce artifact, we have to increase the heart’s signal and reduce the other electrica...
Module 4  Reducing Artifact<br />Artifact Reduction Strategy:<br />Helping the electrode gel to better penetrate the skin ...
Module 4  Reducing Artifact<br />
Module 4  Reducing Artifact<br />Remove hair with electric clippers<br />
Module 4  Reducing Artifact<br />
Module 4  Reducing Artifact<br />Now the skin is prepared, we can attach our electrodes<br />
Module 4  Reducing Artifact<br />
Module 4  Reducing Artifact<br />
Module 5Tips and Techniques<br />Supine is the proper position, if the Pt will tollerate<br />
Module 5Tips and Techniques<br />When the Pt changes position, the heart moves within the chest.  This can cause ECG chang...
Module 5Tips and Techniques<br />Do your best to maintain the modesty of a female Pt<br />
Module 5Tips and Techniques<br />You could try wide medical tape<br />
Module 5Tips and Techniques<br />A folded blanket or towel may help hold the electrodes in place<br />
Module 5Tips and Techniques<br /><ul><li>Strand each lead out individually
 When ECG cables are looped around IV lines, O2 tubing, BP cuff tubing, or dangling between squad bench and stretcher you ...
 Make sure the Pt isn’t twiddling the ECG cables
 If unable to lay supine for ECG, place them semi-fowlers and breathing normally
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Rapid 12 Lead Acquisition

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Slide version of Tim Phalen's Rapid 12 Lead Acquisition course.

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  • I find the information in Rapid 12 Lead Acquisition to be presented in a thorough, and excellently illustrated fashion. I would like to obtain a download, if possible to present to my class of patient care technicians. This would clarify and illustrate proper lead placement and answer many questions that are confusing to them. How may I obtain a download to copy for a classroom presentation?
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Rapid 12 Lead Acquisition

  1. 1. Rapid 12 Lead Acquisition<br />Michael D. Murley<br />
  2. 2. 12 Lead Rapid Acquisition<br /><ul><li> Module 1 Electrode Location
  3. 3. Module 2 Electrode Placement
  4. 4. Module 3 Demonstrations
  5. 5. Module 4 Reducing Artifact
  6. 6. Module 5 Tips and Techniques </li></li></ul><li>Module 1 Electrode Location<br />Electrodes must be placed in the proper position to obtain an accurate 12 Lead ECG<br />
  7. 7. Module 1 Electrode Location<br />12 leads obtained from 10 electrodes<br /><ul><li> 4 on the limbs
  8. 8. 6 on the chest</li></li></ul><li>Module 1 Electrode Location<br />Limb lead positioning is simple.<br />The electrodes are placed off the torso, on the limbs. The most correct positioning is near the wrist and ankles. <br />However, EMS generally places the electrodes on/near the torso to limit artifact while transporting.<br />
  9. 9. Module 1 Electrode Location<br />Chest leads have specific anatomic locations<br />
  10. 10. Module 1 Electrode Location<br />
  11. 11. Module 1 Electrode Location<br />
  12. 12. Module 1 Electrode Location<br />
  13. 13. Module 1 Electrode Location<br />
  14. 14. Module 1 Electrode Location<br />
  15. 15. Module 1 Electrode Location<br />
  16. 16. Module 1 Electrode Location<br />
  17. 17. Module 1 Electrode Location<br />
  18. 18. Module 1 Electrode Location<br />
  19. 19. Module 2 Electrode Placement<br /><ul><li>The key to correctly placing the chest electrodes is finding the 4th intercostal space</li></li></ul><li>Module 2 Electrode Placement<br />
  20. 20. Module 2 Electrode Placement<br />
  21. 21. Module 2 Electrode Placement<br />Here’s another approach to locating the 4th intercostal space<br />
  22. 22. Module 2 Electrode Placement<br />Best view laterally<br />
  23. 23. Module 2 Electrode Placement<br /><ul><li>Locate the supersternal notch (1) at the top of the manubrium
  24. 24. Palpate down appox 2” until you find the sternal angle, slide your finger laterally to the right, you’re finger is now on the 2nd rib
  25. 25. Palpate down into the 2nd 3rd and 4th intercostal space</li></ul>1<br />
  26. 26. Module 2 Electrode Placement<br />After placing V2, palpated down to the 5th intercostal space midclavicular line and place V4<br />
  27. 27. Module 2 Electrode Placement<br />
  28. 28. Module 2 Electrode Placement<br />
  29. 29. Module 2 Electrode Placement<br />
  30. 30. Module 2 Electrode Placement<br />
  31. 31. Module 2 Electrode Placement<br />
  32. 32. Module 2 Electrode Placement<br />
  33. 33. Module 2 Electrode Placement<br />
  34. 34. Module 2 Electrode Placement<br />
  35. 35. Module 2 Electrode Placement<br />
  36. 36. Module 3Demonstrations<br />
  37. 37. Module 3Demonstrations<br />
  38. 38. Module 3Demonstrations<br />
  39. 39. Module 3Demonstrations<br />
  40. 40. Module 3Demonstrations<br />
  41. 41. Module 3Demonstrations<br />
  42. 42. Module 3Demonstrations<br />
  43. 43. Module 3Demonstrations<br />
  44. 44. Module 3Demonstrations<br />
  45. 45. Module 3Demonstrations<br />
  46. 46. Module 3Demonstrations<br />If you were the patient, where would you prefer to have you’re 12 Lead done, in the house or in the truck?<br />
  47. 47. Module 3Demonstrations<br />There’s a lot of people out there and they can see into the ambulance. You should obtain the 12 lead in the house<br />
  48. 48. Module 3Demonstrations<br />
  49. 49. Module 3Demonstrations<br />
  50. 50. Module 3Demonstrations<br />
  51. 51. Module 3Demonstrations<br />
  52. 52. Module 3Demonstrations<br />
  53. 53. Module 3Demonstrations<br />
  54. 54. Module 3Demonstrations<br />
  55. 55. Module 3Demonstrations<br />
  56. 56. Module 3Demonstrations<br />
  57. 57. Module 4 Reducing Artifact<br />Unless you have a clear ECG to analyze, all you interruptive skills are of little use<br />
  58. 58. Module 4 Reducing Artifact<br />Stress labs obtain clear ECG’s while the Patient is running on a treadmill<br />We should be able to obtain a 12 lead while the Patient is laying still<br />
  59. 59. Module 4 Reducing Artifact<br />As the heart depolarizes, an electrode on the Pt’s skin picks up the electrical activity<br />
  60. 60. Module 4 Reducing Artifact<br />It can also pick up other electrical signals<br />
  61. 61. Module 4 Reducing Artifact<br />To reduce artifact, we have to increase the heart’s signal and reduce the other electrical activity<br />
  62. 62. Module 4 Reducing Artifact<br />Artifact Reduction Strategy:<br />Helping the electrode gel to better penetrate the skin will increase the signal strength from the heart and reduce the signal strength from other sources.<br />
  63. 63. Module 4 Reducing Artifact<br />
  64. 64. Module 4 Reducing Artifact<br />Remove hair with electric clippers<br />
  65. 65. Module 4 Reducing Artifact<br />
  66. 66. Module 4 Reducing Artifact<br />Now the skin is prepared, we can attach our electrodes<br />
  67. 67. Module 4 Reducing Artifact<br />
  68. 68. Module 4 Reducing Artifact<br />
  69. 69. Module 5Tips and Techniques<br />Supine is the proper position, if the Pt will tollerate<br />
  70. 70. Module 5Tips and Techniques<br />When the Pt changes position, the heart moves within the chest. This can cause ECG changes similar to a misplaced electrode.<br />
  71. 71. Module 5Tips and Techniques<br />Do your best to maintain the modesty of a female Pt<br />
  72. 72. Module 5Tips and Techniques<br />You could try wide medical tape<br />
  73. 73. Module 5Tips and Techniques<br />A folded blanket or towel may help hold the electrodes in place<br />
  74. 74. Module 5Tips and Techniques<br /><ul><li>Strand each lead out individually
  75. 75. When ECG cables are looped around IV lines, O2 tubing, BP cuff tubing, or dangling between squad bench and stretcher you will have more artifact
  76. 76. Make sure the Pt isn’t twiddling the ECG cables
  77. 77. If unable to lay supine for ECG, place them semi-fowlers and breathing normally
  78. 78. Do not allow Pt to prop themselves up by the arms or you will have muscle tremor artifact</li></li></ul><li>Module 5Tips and Techniques<br /><ul><li> If the Pt is cold/shivering, cover with blanket or sheet prior to capturing the 12 Lead</li></li></ul><li>Module 5Tips and Techniques<br />Same Pt as before, covered with a towel<br />
  79. 79. Module 5Tips and Techniques<br />For some Pt’s obtaining a clear ECG will be difficult (e.g. respiratory distress Pt, sitting up)<br />However, in most cases it is possible to a 12 Lead ECG with excellent, or at least acceptable data quality<br />It just takes effort. A desire to obtain a clean 12 Lead and the knowledge to trouble shoot problems<br />
  80. 80. Module 5Tips and Techniques<br />Myocardial Infarctions are not like broken bones, and therefore, ECG’s are not like X-rays.<br />If you’re treating a Pt with a broken hip. That x-ray could be taken now, 10 min’s from now, an hour from now and what would you see? A broken hip.<br />With MI the events in the coronary artery can be changing moment by moment. The ECG can be very dynamic as well.<br />There is a value to obtaining repeat ECG’s when you suspect MI. Making a habit of doing early and repeat ECG’s will help you identify a STEMI that could easily be missed.<br />
  81. 81. Module 5Tips and Techniques<br />
  82. 82. Module 5Tips and Techniques<br />
  83. 83. Module 5Tips and Techniques<br />This short course provides you with what you need to know in order to rapidly obtain a 12 Lead ECG that’s both clear and accurate<br />Just as the case with ECG interpretation, acquisition also requires practice. After you’ve done this 20 or 30 times, you’ll become comfortable and confident<br />FIN<br />

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