Optional or Required, EMT & AEMT EKG 12-lead Data Acquisition Optional or Required, EMT & AEMT

Course Objectives 1) Define purpose of 12-lead 2) Know the indications for 12-lead 3) Describe the procedure for application 4) Describe the procedure for obtaining 12-lead information 5) Understand complications of 12-lead 6) Understand transmission of 12-lead data 7) Know how to document 12-lead data

Purpose of EKG Electro Cardio Gram (ECG or EKG) allows us to see the electrical activity of the heart Trained professionals are able to interpret rhythm EKGs allow for determining possible: Heart arrhythmias Sites of heart attacks Heart abnormalities

Indications for 12-lead Chest pain, or any anginal symptoms Respiratory problems Overdose Stroke Heart arrhythmias Resuscitation There are no contraindications So use when ever you may think it appropriate

Application of 12-lead 12-lead consists of 10 electrodes Electrode placement is important Electrodes view heart from different directions 12-lead shows 12 different leads Leads I, II, III, aVr, aVl, aVf, and V1-V6 Placement locations 4 limb leads (RA, LA, RL, LL) 6 leads across chest (V1, V2, V3, V4, V5, V6) Placement of electrodes Avoid hair and thick muscle mass (trim hair if needed) Cleanse site with alcohol to remove dirt and oil Then attach

Limb Leads Each limb has a lead Leads can also be moved in to shoulders and abdomen Electrodes should be placed on inside of limbs

Chest (precordial) leads V1- 4th intercostal space on right sternal border V2- 4th intercostal space on left sternal border V3- Between V2 & V4 V4- 5th intercostal space @ midclavicular line V5- level with V4 @ left anterior axillary line V6- level with V5 @ midaxillary line Remember to respect modesty as best as possible

Obtaining the 12-lead Best to do before leaving, if practical Once electrodes are on: Turn monitor on Push 12-lead button Input information that it asks for (age) 12-lead will then start Print 2 strips One for ER upon your arrival One for your documentation Transmit 12-lead (if applicable to your service)

This is a normal adult ECG

82 year old lady with dizzy spells Atrial fibrillation and complete heart block

Complications Patient movement can affect readings Ask patient to hold as still as possible Loose electrodes will either not show readings, or alter them Check electrodes Moving ambulance affects readings Do before leaving or when stopped Loud noise Do everything you can to minimize noise

Transmission Purpose: Saves time in ER for serious patients, they can get to advanced care more quickly Allows hospital to compare current ECG with previous 12-leads of the patient while you are still enroute Physician can compare changes that occurred during your transport Best to do when patient is in pain, signs may not be present on ECG during non-pain

Transmitting basics Each monitor is slightly different in operation and transmission options In general: Hospital needs to be set up to receive transmission 12-leads can be sent to a computer, fax, PDA, etc. Ambulance needs transmitting device (cell phone, radio, Bluetooth, etc.) Once all leads are placed, obtain 12-lead, then transmit according to set up

Documenting Your 12-lead 12-lead data should be included in patient care reports for every patient that receives one Should include: Copy of the 12-lead Time 12-lead was obtained Information about transmission (successful?) If 12-lead was not obtained, but should have been, document reason not obtained

Videos The Videos below give a good general overview of 12-leads. Video on application 12 Lead ECG Placement Part I http://www.youtube.com/watch?v=eA5HmQSMGHE Video on trouble shooting 12 Lead ECG Placement Part II http://www.youtube.com/watch?v=TFcyiCKyaZ4

Skill Overview In the skills station you will be required to: Do initial assessment Establish patient is a candidate for 12-lead Place electrodes properly Acquire 12-lead and print 2 copies Describe transmission and documentation Transport patient

Summary Purpose of the 12-lead is to see electrical activity of heart and help diagnose heart problems Indications include: chest pain, overdoses, strokes, respiratory problems, etc. 10 electrodes are placed on the body with 4 limb leads and 6 chest leads 12-lead is obtained by pushing the 12-lead button on the monitor and inputting information asked for

Summary cont. Complications can include: movement, loose electrodes, and noise Transmission is done after obtaining the 12-lead and uses a transmitting device and a receiving device at the hospital The 12-lead is documented with a copy of the 12-lead and the time it was obtained Attach it to the patient care report