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ECG TRAINING MODULE 2 BY BRAD CHAPMAN RCT. OBJECTIVES 1. PATIENT APPROACH 2. LEAD PLACEMENT 3. ARTIFACT 4. SPECIAL NEEDS PATIENTS.

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Presentation on theme: "ECG TRAINING MODULE 2 BY BRAD CHAPMAN RCT. OBJECTIVES 1. PATIENT APPROACH 2. LEAD PLACEMENT 3. ARTIFACT 4. SPECIAL NEEDS PATIENTS."— Presentation transcript:

1 ECG TRAINING MODULE 2 BY BRAD CHAPMAN RCT

2 OBJECTIVES 1. PATIENT APPROACH 2. LEAD PLACEMENT 3. ARTIFACT 4. SPECIAL NEEDS PATIENTS

3 The Approach Enter to the left hand side of the patient Enter to the left hand side of the patient Ensure them that this test doesn't hurt Ensure them that this test doesn't hurt Make sure curtain is pulled across for the women 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 Ask the Men if they want the curtain pulled – most won't but occasional one will

4 Patient Preparation Tell patient that you are going to place stickers on them and then connect some wires 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 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

5 Placement of Leads Find the first intercoastal space by moving a finger down the right collar bone towards the sternum. Stop a ½ “ before the sternum 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 Rock fingers down chest counting the intercostal spaces Count down to the 4 th intercostal space Count down to the 4 th intercostal space Place a sticker there Place a sticker there Repeat process on the other side of the sternum Repeat process on the other side of the sternum

6 Placement of leads Draw a vertical line from mid-clavicular to under the breast and place a sticker. This will be V4. 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 Visual drop a horizontal line straight line down from v4 to mid-auxilla and place a sticker (v6) 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 Place a sticker between v4 and v6 – this will be your v5 lead

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8 Chest Lead Placement All chest leads are labelled v1, v2, v3,...v6. All chest leads are labelled v1, v2, v3,...v6. All leads are color coded. All leads are color coded. Chest leads are Chest leads are Red Red Yellow Yellow Green Green Blue Blue Orange Orange Purple Purple

9 Easy to remember Stop Light Stop Light Red, Yellow, Green Red, Yellow, Green BOP BOP Blue, Orange, Purple Blue, Orange, Purple

10 Artifact There are different types of artifact There are different types of artifact Somatic tremors (muscle artifact) – most common Somatic tremors (muscle artifact) – most common Wandering baseline Wandering baseline AC interference AC interference

11 Somatic Tremors (Muscle artifact) CAUSE Most common type of artifact Most common type of artifact Caused by patient moving limbs, fingers, nervous, restless, or anxious Caused by patient moving limbs, fingers, nervous, restless, or anxiousREMEDY Try to have the patient relax and hold still Try to have the patient relax and hold still Try talking in a calming Try talking in a calming voice while doing the tracing voice while doing the tracing Move limb stickers higher Move limb stickers higher up the limb up the limb

12 Wandering Baseline CAUSE Patient is moving or stickers are not making a good contact Patient is moving or stickers are not making a good contact Cables may be dangling or swaying Cables may be dangling or swayingREMEDY Place a towel on chest leads Place a towel on chest leads to weight them down to weight them down Apply pressure to lead Apply pressure to lead with a towel

13 AC Interference Consistent and regular saw tooth pattern Consistent and regular saw tooth patternREMEDY Turn off all cell phones and other electronic devices (possibly lights) Turn off all cell phones and other electronic devices (possibly lights) Unplug electric bed Unplug electric bed TENS machines must TENS machines must be turned off to do ECG be turned off to do ECG Place ECG machine further Place ECG machine further away from ventilators, IV pumps X-Ray equipment X-Ray equipment Radio and TV Radio and TV

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15 Where is that Artifact coming from? If there is artifact in Check this connection these leads Lead I and IIRA Lead I and IIRA Lead I and IIILA Lead I and IIILA Lead II and IIILL Lead II and IIILL OR OR Tap on or shake the limb lead and see where the interference is coming from Tap on or shake the limb lead and see where the interference is coming from

16 Special Needs Patient Amputees Amputees Burns Burns Tremors Tremors Paediatrics Paediatrics Wheelchair Wheelchair Trauma Trauma SOB SOB Acute MI Acute MI Psychiatric Psychiatric

17 AMPUTEES Place lead further up the limb or even on the hip or shoulder 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 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

18 BURNS Place leads on parts of the skin that are not burnt Place leads on parts of the skin that are not burnt Do not remove any clothing that is stuck to the skin 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 Take alligator clip off the end of the lead, clean with alcohol and hold the tip of the lead on the skin lightly

19 TREMORS Parkinson’s disease Parkinson’s disease Place hands underneath the buttocks Place hands underneath the buttocks Place electrodes on Hips or Shoulders Place electrodes on Hips or Shoulders Add extra pillow under knees Add extra pillow under knees

20 PEDIATRICS Getting small children to hold still during an ECG may be challenging Getting small children to hold still during an ECG may be challenging Distraction with toys or Music Distraction with toys or Music Young infants, place stickers on then wrap in a blanket Young infants, place stickers on then wrap in a blanket

21 WHEELCHAIR Assist to transfer to bed Assist to transfer to bed If they can’t move to bed – do ECG in the chair 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) Record on the ECG that done while sitting up. (Changes the axis of the heart)

22 TRAUMA Remain calm – work at putting on stickers while the medical team does their task Remain calm – work at putting on stickers while the medical team does their task Place your stickers on and hook up wires Place your stickers on and hook up wires Communicate to the trauma team when you are ready to acquire the tracing 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 When ready tell the trauma team not to move them for 10 seconds

23 RESPIRATORY DISTRESS The patient in respiratory distress is difficult to obtain an ECG on 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 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) Place limb leads higher up (Shoulders & Hips)

24 CHEST TUBES Place all electrodes you can without moving bandages Place all electrodes you can without moving bandages You will probably have to leave leads V5 and V6 off 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. Take extra precautions around the chest tube. Seek help if it appears to be loose.

25 ACUTE MYOCARDIAL INFARCTION Remain calm Remain calm Leave stickers on if you will be doing serials ECG’s. This will accurately measure changes due to MI and not movement Leave stickers on if you will be doing serials ECG’s. This will accurately measure changes due to MI and not movement

26 PSYCHIATRIC Be very reassuring when it comes to explaining the exam Be very reassuring when it comes to explaining the exam Explain the test in layman terms Explain the test in layman terms Never use the word “electro” Never use the word “electro” Always call an ECG a “Cardiogram” or Heart Tracing Always call an ECG a “Cardiogram” or Heart Tracing ECG sounds like ECT (shock therapy) ECG sounds like ECT (shock therapy)

27 REVIEW QUIZ! Thank you for your time. Thank you for your time.


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