1. The Perils and Pitfalls of ECG Recording Jane Mackenzie Chris Monaco

2. What is an ECG and Why do we record it? An ECG records the electrical activity of the heart muscle ECG recordings are used to- Identify normal and abnormal heart rhythms To diagnose life threatening conditions To detect heart attacks To determine the next course of action or treatment for the patient.

3. How Do we Record it? To record an ECG you need An ECG machine and cables A comfortable couch A warm environment Electrodes Privacy A TRAINED competent operator Oh............ and a patient !!!

4. Perils and Pitfalls You could put electrodes in the wrong place YOU CAN MISS A HEART ATTACK You use the wrong machine settings You can hide or create abnormal waveforms and therefore the patient could get the Wrong Diagnosis The recording is of poor quality It cannot be interpreted

5. ECG waveforms should look like this..

6. Muscle Electrical Wandering baseline And NOT like this !

7. How to record an ECG https://www.youtube.com/watch?v=lrjAYCi 1duIhttps://www.youtube.com/watch?v=lrjAYCi 1duI

8. Patient Care Patient is informed Environment is safe Relaxed and comfortable Identified ( 3 points) and consented Lie patient on couch/ bed Semi supine position as per guidance

9. Follow the Guidelines Place electrodes on limbs In correct position Trained operator is available Feel and count the rib spaces Always be accurate Leeway – there isn’t any ! Learn how to record an artefact free ECG Select the correct machine settings

10. This ECG is perfect ! Are yours ??

11. ECG Training at Bradford PCTC Block One – Practical ECG recording Block Two – Interpret a Normal ECG Block Three - Recognise Abnormal Rhythms Block Four - Acute Coronary Syndrome ( identify heart attacks on the ECG)