Download presentation
Presentation is loading. Please wait.
1
STEMI Recognition Class
12 and 15 Lead Acquisition STEMI Recognition Class
2
12 Lead Rapid Acquisition
Module 1 Electrode Location Module 2 Electrode Placement Module 3 How to do a 15 Lead Module 4 Demonstrations Module 5 Reducing Artifact Module 6 Tips and Techniques
3
Module 1 Electrode Location
Electrodes must be placed in the proper position to obtain an accurate 12 Lead ECG
4
Module 1 Electrode Location
12 leads obtained from 10 electrodes 4 on the limbs 6 on the chest
5
Module 1 Electrode Location
Limb lead positioning is simple. The electrodes are placed off the torso, on the limbs. The most correct positioning is near the wrist and ankles. However, EMS generally places the electrodes on/near the torso to limit artifact while transporting.
6
Module 1 Electrode Location
Chest leads have specific anatomic locations V1, V2, V4 the rest are placed in relationship to these leads
7
Module 1 Electrode Location
8
Module 1 Electrode Location
9
Module 1 Electrode Location
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 2 Electrode Placement
The key to correctly placing the chest electrodes is finding the 4th intercostal space
16
Module 2 Electrode Placement
17
Module 2 Electrode Placement
18
Module 2 Electrode Placement
Here’s another approach to locating the 4th intercostal space
19
Module 2 Electrode Placement
Best view laterally
20
Module 2 Electrode Placement
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 the 2nd rib Palpate down into the 2nd 3rd and 4th intercostal space 1
21
Module 2 Electrode Placement
After placing V2, palpated down to the 5th intercostal space midclavicular line and place V4
22
Module 2 Electrode Placement
15 Leads are simple Remove V4 and move it 5th intercostal space, midclivicular on the Right side of Pt’s chest V1 V2 V3 V4R V4
23
Module 2 Electrode Placement
15 Leads are simple Remove V4 and move it 5th intercostal space, midclavicular on the Right side of Pt’s chest
24
Module 2 Electrode Placement
25
Module 2 Electrode Placement
26
Module 2 Electrode Placement
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 3 Demonstrations
34
Module 3 Demonstrations
35
Module 3 Demonstrations
36
Module 3 Demonstrations
37
Module 3 Demonstrations
38
Module 3 Demonstrations
39
Module 3 Demonstrations
40
Module 3 Demonstrations
41
Module 3 Demonstrations
42
Module 3 Demonstrations
43
Module 3 Demonstrations
If you were the patient, where would you prefer to have you’re 12 Lead done, in the house or in the truck?
44
Module 3 Demonstrations
There’s a lot of people out there and they can see into the ambulance. You should obtain the 12 lead in the house
45
Module 3 Demonstrations
46
Module 3 Demonstrations
47
Module 3 Demonstrations
48
Module 3 Demonstrations
49
Module 3 Demonstrations
50
Module 3 Demonstrations
51
Module 3 Demonstrations
52
Module 3 Demonstrations
53
Module 3 Demonstrations
54
Practice Time
55
Module 4 Reducing Artifact
Unless you have a clear ECG to analyze, all you interruptive skills are of little use
56
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
57
Module 4 Reducing Artifact
As the heart depolarizes, an electrode on the Pt’s skin picks up the electrical activity
58
Module 4 Reducing Artifact
It can also pick up other electrical signals
59
Module 4 Reducing Artifact
To reduce artifact, we have to increase the heart’s signal and reduce the other electrical activity
60
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.
61
Module 4 Reducing Artifact
62
Module 4 Reducing Artifact
Remove hair with electric clippers
63
Module 4 Reducing Artifact
64
Module 4 Reducing Artifact
Now the skin is prepared, we can attach our electrodes
65
Module 4 Reducing Artifact
66
Module 4 Reducing Artifact
67
Module 5 Tips and Techniques
Supine is the proper position, if the Pt will tollerate
68
Module 5 Tips and Techniques
When the Pt changes position, the heart moves within the chest. This can cause ECG changes similar to a misplaced electrode.
69
Module 5 Tips and Techniques
Do your best to maintain the modesty of a female Pt
70
Module 5 Tips and Techniques
You could try wide medical tape
71
Module 5 Tips and Techniques
A folded blanket or towel may help hold the electrodes in place
72
Module 5 Tips and Techniques
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 will have more artifact Make sure the Pt isn’t twiddling the ECG cables If unable to lay supine for ECG, place them semi-fowlers and breathing normally Do not allow Pt to prop themselves up by the arms or you will have muscle tremor artifact
73
Module 5 Tips and Techniques
If the Pt is cold/shivering, cover with blanket or sheet prior to capturing the 12 Lead
74
Module 5 Tips and Techniques
Same Pt as before, covered with a towel
75
Module 5 Tips 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
76
Module 5 Tips 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.
77
Module 5 Tips and Techniques
78
Module 5 Tips and Techniques
79
Does Lead I show Global Negativity?
12 lead Validation Does Lead I show Global Negativity?
80
12 lead Validation Limb Reversal!
81
12 lead Validation Look for R Wave Progression in the pre-cordial leads. The QRS should go from negative to more positive.
82
Validate this 12 lead
83
Module 5 Tips 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
Similar presentations
