1. EKG Plain Simple Plain and Simple CHAPTER Third Edition Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Technical Aspects of the EKG 4

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis The EKG Machine Electrically speaking, the heart is a transmitter and the EKG machine is the receiver

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-1 Man Attached to EKG Machine

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Control Features Chart speed: Regulates speed of EKG printout. Normal speed is 25 mm/second Gain: Regulates the amplitude of the EKG waves and complexes. Normal setting is 1 Document any change in settings

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrical Safety Macroshock: High-voltage shock that allows 110 volts to travel through skin –Caused by: Inadequate grounding of electrical equipment (frayed/broken wires or cords, electrical outlet damage, or other) –Results in: Burns, neurologic damage, fatality

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrical Safety Microshock: Smaller shock that travels up a conduit into the heart (pacemaker, etc.) –Caused by: Frayed grounding wire or other –Results in: Burns, neurologic damage, fatality

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrical Safety ALWAYS CHECK FOR FRAYED WIRES OR COMPONENTS BEFORE DOING AN EKG NEVER USE A FAULTY MACHINE

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. EllisArtifact Unwanted jitter or interference on the EKG tracing Four kinds –Somatic tremors –Baseline sway –60-cycle interference –Broken recording

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-2 Somatic Tremors Artifact

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-3 Baseline Sway

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-4 60-Cycle Interference

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-5 Broken Recording

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. EllisTroubleshooting Involves determining and alleviating the cause of artifact and recording errors Find the common limb of the affected leads and direct corrective efforts there May involve replacing electrode patches or reattaching loose or detached wires If artifact is on cardiac monitor in hospital, can change lead selector switch to monitor rhythm in another (clearer) lead

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Artifact Troubleshooting Practice 1

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Artifact Troubleshooting Practice 2

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Artifact Troubleshooting Practice 3

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Artifact Masquerading as Asystole The rhythm looks like asystole (flat-line), but is artifact. Several monitor wires and patches were loose or disconnected. The patient was fine

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-7 Artifact Masquerading as Asystole (Flat-Line)

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis True Asystole The next slide is true asystole. This patient has no pulse and is not breathing. It looks the same as the previous strip, doesn’t it?

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-8 True Asystole

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Toothbrush Tachycardia The next slide is from a man who was brushing his teeth. The arm movements jiggled the EKG wires and created what appeared to be a dangerous rhythm

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-9 “Toothbrush Tachycardia” masquerading as a rhythm

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis True Lethal Rhythm The next slide is a true rhythm. Looks a lot like the previous strip, doesn’t it?

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 4-10 Ventricular Tachycardia, a potentially lethal rhythm

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis CPR Artifact Seen during CPR Can resemble ventricular rhythms May cause health care personnel to think there is a rhythm when there is not