This document provides instructions on obtaining a 12-lead electrocardiogram (ECG or EKG). It covers electrode placement, identifying the correct intercostal spaces for chest leads, demonstrating techniques, reducing artifact, and tips. Key points include using gel to improve skin contact and signal strength, cleaning skin first, and troubleshooting to get clear readings, as accurate ECG interpretation requires a high-quality tracing. With practice, paramedics can learn to rapidly obtain 12-lead ECGs even in challenging patients or situations.

1. Rapid 12 Lead Acquisition Michael D. Murley

3. Module 2 Electrode Placement

4. Module 3 Demonstrations

5. Module 4 Reducing Artifact

9. Module 1 Electrode Location Chest leads have specific anatomic locations V1, V2, V4 the rest are placed in relationship to these leads

10. Module 1 Electrode Location

11. Module 1 Electrode Location

12. Module 1 Electrode Location

13. Module 1 Electrode Location

14. Module 1 Electrode Location

15. Module 1 Electrode Location

16. Module 1 Electrode Location

17. Module 1 Electrode Location

18. Module 1 Electrode Location

20. Module 2 Electrode Placement

21. Module 2 Electrode Placement Here’s another approach to locating the 4th intercostal space

22. Module 2 Electrode Placement Best view laterally

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. Palpate down into the 2nd 3rd and 4th intercostal space1

26. Module 2 Electrode Placement After placing V2, palpated down to the 5th intercostal space midclavicular line and place V4

27. Module 2 Electrode Placement

28. Module 2 Electrode Placement

29. Module 2 Electrode Placement

30. Module 2 Electrode Placement

31. Module 2 Electrode Placement

32. Module 2 Electrode Placement

33. Module 2 Electrode Placement

34. Module 2 Electrode Placement

35. Module 2 Electrode Placement

36. Module 3Demonstrations

37. Module 3Demonstrations

38. Module 3Demonstrations

39. Module 3Demonstrations

40. Module 3Demonstrations

41. Module 3Demonstrations

42. Module 3Demonstrations

43. Module 3Demonstrations

44. Module 3Demonstrations

45. Module 3Demonstrations

46. Module 3Demonstrations If you were the patient, where would you prefer to have you’re 12 Lead done, in the house or in the truck?

47. Module 3Demonstrations There’s a lot of people out there and they can see into the ambulance. You should obtain the 12 lead in the house

48. Module 3Demonstrations

49. Module 3Demonstrations

50. Module 3Demonstrations

51. Module 3Demonstrations

52. Module 3Demonstrations

53. Module 3Demonstrations

54. Module 3Demonstrations

55. Module 3Demonstrations

56. Module 3Demonstrations

57. Module 4 Reducing Artifact Unless you have a clear ECG to analyze, all you interruptive skills are of little use

58. Module 4 Reducing Artifact Stress labs obtain clear ECG’s while the Patient is running on a treadmill We should be able to obtain a 12 lead while the Patient is laying still

59. Module 4 Reducing Artifact As the heart depolarizes, an electrode on the Pt’s skin picks up the electrical activity

60. Module 4 Reducing Artifact It can also pick up other electrical signals

61. Module 4 Reducing Artifact To reduce artifact, we have to increase the heart’s signal and reduce the other electrical activity

62. Module 4 Reducing Artifact Artifact Reduction Strategy: 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.

63. Module 4 Reducing Artifact

64. Module 4 Reducing Artifact Remove hair with electric clippers

65. Module 4 Reducing Artifact

66. Module 4 Reducing Artifact Now the skin is prepared, we can attach our electrodes

67. Module 4 Reducing Artifact

68. Module 4 Reducing Artifact

69. Module 5Tips and Techniques Supine is the proper position, if the Pt will tollerate

70. Module 5Tips and Techniques When the Pt changes position, the heart moves within the chest. This can cause ECG changes similar to a misplaced electrode.

71. Module 5Tips and Techniques Do your best to maintain the modesty of a female Pt

72. Module 5Tips and Techniques You could try wide medical tape

73. Module 5Tips and Techniques A folded blanket or towel may help hold the electrodes in place

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. Make sure the Pt isn’t twiddling the ECG cables

77. If unable to lay supine for ECG, place them semi-fowlers and breathing normally

79. Module 5Tips and Techniques For some Pt’s obtaining a clear ECG will be difficult (e.g. respiratory distress Pt, sitting up) However, in most cases it is possible to a 12 Lead ECG with excellent, or at least acceptable data quality It just takes effort. A desire to obtain a clean 12 Lead and the knowledge to trouble shoot problems

80. Module 5Tips and Techniques Myocardial Infarctions are not like broken bones, and therefore, ECG’s are not like X-rays. 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. With MI the events in the coronary artery can be changing moment by moment. The ECG can be very dynamic as well. 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.

81. Module 5Tips and Techniques

82. Module 5Tips and Techniques

83. Module 5Tips and Techniques 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 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 FIN