Presentation is loading. Please wait.

Presentation is loading. Please wait.

STEMI Recognition Class

Similar presentations

Presentation on theme: "STEMI Recognition Class"— Presentation transcript:

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

Download ppt "STEMI Recognition Class"

Similar presentations

Ads by Google