The 12-lead ECG is a diagnostic test that helps identify conditions like acute coronary syndrome and myocardial infarction. Obtaining a 12-lead ECG in the field is important to identify ST elevations that could indicate a heart attack and speed up treatment times. The placement of the ECG leads and the patterns in the complexes can provide clues to determine the type and location of any heart issues. It is important for paramedics to become proficient in performing and interpreting 12-lead ECGs to help ensure the best outcomes for patients experiencing potential cardiac events.

1. 12 Lead ECG Heidi Whitman, ICP Paramedic

2. Role of the 12 Lead

7. A picture of the heart

9. Lead Placement

12. Let’s Practice!

15. Waveforms The PR interval should be no longer than 0.20s, or 5 little squares. The length of the QRS should be shorter than 0.12s, or 3 little squares.

19. ST segment Gross elevation is often described as tombstoning, or a fireman’s hat

28. AMI

30. SALLI S =septal, A =anterior, L =(low) lateral, L =(high) lateral, I =inferior Memorize this as an aid to locating AMI’s on the heart!

33. Septal MI Which leads are the septal leads?

34. Anterior MI What kind of block is this? LBBB or RBBB?

35. Lateral MI Where else is there involvement? Are there reciprocal changes?

36. Lateral MI Reciprocal changes? Is this high lateral or low lateral?

37. Inferior MI Do you think the depression in the precordial leads is reciprocal or ischemic? Which coronary artery can cause this much damage?

38. Right sided MI This good medic marked V4R on her 12 lead  What made this medic suspect right sided involvement?

39. Posterior MI What made this medic suspect posterior MI?

40. Ya, I feel that way too… don’t worry, we’re almost done!

47. All Done!! Time to do Bad things To our Arteries!!