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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 midclavicular line
V5- level with left anterior axillary line
V6- level with midaxillary line
Remember to respect modesty as best as possible

8. 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)

9. This is a normal adult ECG

10. 82 year old lady with dizzy spells
Atrial fibrillation and complete heart block

11. 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

12. 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

13. 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

14. 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

15. Videos The Videos below give a good general overview of 12-leads.
Video on application
12 Lead ECG Placement Part I
Video on trouble shooting
12 Lead ECG Placement Part II

16. 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

17. 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

18. 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