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12 and 15 Lead Acquisition STEMI Recognition Class.

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Presentation on theme: "12 and 15 Lead Acquisition STEMI Recognition Class."— Presentation transcript:

1 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








15 Module 2 Electrode Placement The key to correctly placing the chest electrodes is finding the 4 th intercostal space

16 Module 2 Electrode Placement


18 Here’s another approach to locating the 4 th 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 2 nd rib Palpate down into the 2 nd 3 rd and 4 th intercostal space

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

22 Module 2 Electrode Placement V1 V2 V3 V4 V4R 15 Leads are simple Remove V4 and move it 5 th intercostal space, midclivicular on the Right side of Pt’s chest

23 Module 2 Electrode Placement 15 Leads are simple Remove V4 and move it 5 th intercostal space, midclavicular on the Right side of Pt’s chest

24 Module 2 Electrode Placement









33 Module 3 Demonstrations










43 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









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 Remove hair with electric clippers

63 Module 4 Reducing Artifact

64 Now the skin is prepared, we can attach our electrodes

65 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


79 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

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