1 intro

527 views
437 views

Published on

Published in: Health & Medicine, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
527
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
36
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • There is no diagnostic tool in prehospital emergency medicine, more important than the 12-lead electrocardiogram. In this course we are going to discuss how the 12-lead ECG works, and how we can use it to discover a number of pathologies.   This is a comprehensive course of 12-lead electrocardiography.   Lets begin lesson 1.
  • There are a number of things that you can discover from a 12-lead ECG reading.   The closer you look with a keen eye, the better your chances are of discovering valuable information.
  • Before we get started wit
  • You can troubleshoot artifact in a logical manner. If one of the precordial leads has artifact, check that lead. If leads 1 & 3 are showing some artifact, check the left shoulder. You should check the right shoulder if leads 1 & 2 have artifact and the left leg if leads 2 & 3 are of poor quality.
  • All modern 12-lead monitors currently use the GE Marquette 12SL interpretive algorhythm to perform automated ECG interpretations. These printed interpretations can be unpredictable and unreliable at times. As you can imagine, the accuracy of the interpretive algorhythm is very dependant on a clean ECG tracing.
  • All modern 12-lead monitors currently use the GE Marquette 12SL interpretive algorhythm to perform automated ECG interpretations. These printed interpretations can be unpredictable and unreliable at times. As you can imagine, the accuracy of the interpretive algorhythm is very dependant on a clean ECG tracing.
  • This is the basic layout of a 12-lead ECG.
  • The standard calibration mark can show up at the beginning or end of the ECG, and the base of the calibration mark provides your iso-electric line.
  • Look in the red box on this 12-lead. That is a continuous rhythm. The only thing that changes is the lead that the rhythm is viewed in. In fact the two rows above it are continuous rhythms as well.
  • Now look at this red box. All three QRS complexes in the red box are the same complex. The only difference is the lead that they are viewed from. That is true for every other column of QRS complexes on a 12-Lead.
  • The first thing you should do with any 12-lead ECG is confirm lead placement. Lead 1 should be positive and aVR negative in almost every 12-lead. There are some circumstances where they wont be and we will cover them. If lead 1 is negative and aVR is positive, check the limb leads to confirm proper lead placement.
  • The precordial leads are those directly on the chest. The “right” precordial leads are leads V1 through V3, and the “left” precordial leads are leads V4 through V6.
  • Contiguous leads are are leads that look at the same portion of the heart. We will discuss this in more detail later. Look at this image, the leads of the same color are contiguous.
  • aVR looks at basal portion of septum
  • Is it a left axis deviation (left superior axis), which might suggest left anterior fascicular block, inferior MI, or paced rhythm? Is it a right axis deviation (right inferior axis), which might suggest left posterior fascicular block, lateral MI, right ventricular hypertrophy or acute right-sided strain? Is it an extreme axis deviation (right superior axis), which might suggest VT, electrolyte derangement, or misplaced limb lead electrodes? Notice R-wave progression, the transition, and whether or not there is positive or negative concordance of QRS complexes in the precordial leads.
  • Is it a left axis deviation (left superior axis), which might suggest left anterior fascicular block, inferior MI, or paced rhythm? Is it a right axis deviation (right inferior axis), which might suggest left posterior fascicular block, lateral MI, right ventricular hypertrophy or acute right-sided strain? Is it an extreme axis deviation (right superior axis), which might suggest VT, electrolyte derangement, or misplaced limb lead electrodes? Notice R-wave progression, the transition, and whether or not there is positive or negative concordance of QRS complexes in the precordial leads.
  • Is it a left axis deviation (left superior axis), which might suggest left anterior fascicular block, inferior MI, or paced rhythm? Is it a right axis deviation (right inferior axis), which might suggest left posterior fascicular block, lateral MI, right ventricular hypertrophy or acute right-sided strain? Is it an extreme axis deviation (right superior axis), which might suggest VT, electrolyte derangement, or misplaced limb lead electrodes? Notice R-wave progression, the transition, and whether or not there is positive or negative concordance of QRS complexes in the precordial leads.
  • Is it a left axis deviation (left superior axis), which might suggest left anterior fascicular block, inferior MI, or paced rhythm? Is it a right axis deviation (right inferior axis), which might suggest left posterior fascicular block, lateral MI, right ventricular hypertrophy or acute right-sided strain? Is it an extreme axis deviation (right superior axis), which might suggest VT, electrolyte derangement, or misplaced limb lead electrodes? Notice R-wave progression, the transition, and whether or not there is positive or negative concordance of QRS complexes in the precordial leads.
  • Is it a left axis deviation (left superior axis), which might suggest left anterior fascicular block, inferior MI, or paced rhythm? Is it a right axis deviation (right inferior axis), which might suggest left posterior fascicular block, lateral MI, right ventricular hypertrophy or acute right-sided strain? Is it an extreme axis deviation (right superior axis), which might suggest VT, electrolyte derangement, or misplaced limb lead electrodes? Notice R-wave progression, the transition, and whether or not there is positive or negative concordance of QRS complexes in the precordial leads.
  • 1 intro

    1. 1. 12-LeadElectrocardiography a comprehensive course In tro Adam Thompson, EMT-P, A.S.
    2. 2. Resource
    3. 3. Course Objectives•Learn the basic concept behind electrical vectors.•Learn the 6 step process to 12-lead ECGinterpretation.•Learn how to identify chamber enlargement.•Learn how to differentiate between atrial & ventricularrhythms.•Learn how to identify bundle branch blocks.•Learn how to differentiate a STEMI from STE-Mimic•Learn when to perform a right-sided or posterior 12-lead ECG.
    4. 4. This Introduction• Learn the appropriate placement of the 12- lead ECG electrodes.• Learn how to eliminate artifact and obtain a clean recording.• Learn the components of a 12-lead ECG strip• Learn about the 6 step interpretation process.
    5. 5. 12-Lead ECG“In lead II? You’ve got NO clue.” - Bob Page
    6. 6. 12-Lead Placement V1 - 4th ICS, right of sternum V2 - 4th ICS, left of sternum V3 - Between V2 & V4 V4 - 5th ICS, left midclavicular line V5 - Lateral to V4, left anterior axillary line V6 - Lateral to V5, left midaxillary line
    7. 7. Eliminate Artifact• The patient’s chest should be bare.• All hair that inhibits adequate electrode contact should be shaved.• Benzoin tincture may be used to enhance adhesive.
    8. 8. The Culprit Electrode• Precordial leads are easy. V1 has artifact? Check V1 electrode.• If Leads I & III have artifact, check left shoulder.• If Leads I & II have artifact, check right shoulder.• Leads II & III? Check left leg electrode.
    9. 9. 12-Lead Basics• Measurements are usually accurate
    10. 10. 12-Lead Basics• GE-Marquette 12SL Interpretive Algorhythm – Relatively reliable on clean ECG tracing.
    11. 11. 12-Lead Basics• The patient age and gender should always be entered into the 12-lead monitor.
    12. 12. 12-Lead BasicsTypical 12-Lead ECG
    13. 13. 12-Lead BasicsTypical 12-Lead ECG
    14. 14. 12-Lead BasicsTypical 12-Lead ECG
    15. 15. 12-Lead BasicsTypical 12-Lead ECG
    16. 16. 12-Lead BasicsTypical 12-Lead ECG
    17. 17. Precordial LeadsPrecordium - area of chest over heart
    18. 18. Limb Leads• Obtained from Red, White, Black, & Green electrodes
    19. 19. 12 Leads Limb Leads Precordial LeadsLead I aVR V1 V4Lead II aVL V2 V5Lead III aVF V3 V6
    20. 20. Contiguous LeadsLead I aVR V1 V4Lead II aVL V2 V5Lead III aVF V3 V6
    21. 21. Contiguous LeadsLead I aVR V1 V4 high lateral septal anteriorLead II aVL V2 V5 inferior high lateral septal low lateralLead III aVF V3 V6 inferior inferior anterior low lateral
    22. 22. The 6-Step Method• 1. Rate & Rhythm• 2. Axis Determination• 3. Intervals• 4. Morphology• 5. STE-Mimics• 6. Ischemia, Injury, & Infarct
    23. 23. The 6-Step Method Rate & Rhythm• What is your initial rhythm interpretation?• Is the rhythm too fast or too slow?• Are we certain it is supraventricular?• If the QRS complexes are wide, it is ventricular until proven otherwise.
    24. 24. The 6-Step Method Axis Determination• Is the axis normal?• Is it left axis deviation?• Is it right axis deviation?• Extreme right axis deviation?• Consider pathologies!
    25. 25. The 6-Step Method Intervals• Double check PR-interval and QRS duration• Identify the QT or QTc interval• Consider pathologies for abnormal intervals.
    26. 26. The 6-Step Method Morphology• If QRS is wide, what is morphology in V1?• Bundlebranch block?• Bifascicular block?• Identify chamber enlargement.• Consider T-wave morphology• Consider possible pathologies that correlate with altered morphologies.
    27. 27. The 6-Step Method STE-Mimics• Determine if a paced rhythm, LBBB, LVH, Early repol, pericarditis, WPW, or hyperkalemia is present.• By this step, many possible pathologies have already been ruled out or in.
    28. 28. The 6-Step Method Ischemia, Injury, & Infarct• Is it an obvious STEMI? ie. Tombstones?• Identify ST-elevation, & ST-depression.• Identify hyperacute T-waves or Q-waves.• Consider reciprocal changes.• Do you show changes in contiguous leads?• Consider culprit artery, and affected area of the heart.
    29. 29. 12-Lead Basics
    30. 30. The End• See you in the next module!

    ×