Ambulatory ECG Flashcards
What would symptoms be that require a monitor?
Syncope: a transient loss of conciousness, usually leading to a fall
The onset is rapid & spontaneous
Palpitations: refers to the increased awareness of one’s own heartbeat, it can be malignant or benign.
It can be forceful, unpleasant, described as heart pounding, like it will burst out of the chest
It can be related to anxiety or from stimulants
- Malignant HR: tachycardia, ventricular ectopic, less than 10% is normal/benign
- If patients may experience ectopics and be given beta-blockers
- PHT- postural hypertension, BP drops when we change positions from sitting to standing
- Pressing on carotid artery stimulates baroreceptors in the neck causing syncope
- Diabetics: sugar level drop causing passing out
What are the advantages of using the smoother newer model?
Smooth model is less likely to catch on clothing & easier to clean, cover in a plastic covering to protect device from getting wet. 1K per monitor
App is connected now to monito via bluetooth
Describe the lifecard configuration
Log on to sentinel and select halter
Memory card- set patient data
Car reader- contains pins so place card in the right way
Configure the car by selecting the patient
Describe the application process of a monitor
Explanation, explain test to patient fully and recieve verbal consent, no surprises to patient
Consent from the patient to wear the monitor
Reassurance, it will not shock them
Guidance, how to use it, don’t get it wet, longer than 7 days give sticky electrodes to reapply after shower
Elderly people have frail skin be careful when peeling off electrodes
Do’s and Do nots, don’t shower or be too close to technology with life cards
What is the purpose of the diary sheet
Diary sheet: place name & DOB, add symptoms, time and date of symptoms and what activity they were doing when they felt the symptoms, sleep & wake up times for tape analysis, exercise, stimulants, eating enters rest and digest date, HR lowers.
Describe how to prepare the equipment to monitor
Card
Pen to write patient details on card
Voice recording, DOB, name, NHS number
Programme
Clean device
New battery triple A
Keep patients separate to prevent a mix-up,
Describe the skin preparation needed before application
Shave the skin if necessary, remove outer layer of skin (abrade) as it is dead & dry, dead cells do not conduct electricity well, reconfigure if skin has ezcema or scar tissue
Clean the skin, remove oil, grease & moistuizer, allow the base of electrode to stick firmly
Do not over prep the skin as it will cause an increased impedance
Describe the checks needed for electrodes
Application of electrodes:
Use good quality electrodes with a larger contact area
Silver chloride
Porous material
Offset stud
Check expirary date & packaging of electrodes
Check hypersensitivity, if skin starts to be irritated or hurt, take off electrodes and exchange them
What are the positions for the 3 electrodes and what do they measure
Yellow, CH1-CH3+, right sternal, 2nd rib space
Red, CH1+CH2+, left anterior axillary line on 6th rib
Green: CH2-CH3+, right anterior axillary line on 6th rib
Describe what to do upon patient return
Remove the card before removing the monitor/electrodes
Check for any skin reactions e.g., rash
Detach the recorder from the patient
Remove of the used battery and dispose of it
Clean the patient cables
Describe problems that may occur during recording
Movement artefact
Morphology changes
Wandering baseline
AC iterference
The patient
Recording cables
Describe what to do if a cable breaks/ artefacts from movement
Replace the electrode and cable
identified by 16Hz signal superimposed on ECG signal
Movement artefact: redo skin prep and reposition electrodes
when repositioning electrodes try get a clear signal, avoid a biphasic QRS complex
Ask patient to move to ensure a stable ECG signal, if unstable reposition electrodes
