Performing a 12 lead ECG and Troubleshooting

Question 1

What is an ECG?

Answer 1

A graphical representation of the heart’s electrical activity that occurs over time.

Cardiac depolarisation and repolarisation generates electrical currents which spread throughout the body - measured by electrodes placed on the body surface.

Producing a snapshot of the patients heart rate and rhythm in addition to other aspects of cardiac electrical activity

Question 2

Indications for an ECG

Answer 2

• Dizziness *Irregular pulse
  Screening * Loss of consciousness
• Shortness of breath * Fall
• Heart murmur * Hypotension
• Suspected MI * Research
• Chest Pain * Pre-operative assessment

Question 3

Contraindications

Answer 3

Relative – Sensitivity to electrodes
Absolute – Patient refusal

Question 4

Performing a 12 Lead ECG

Answer 4

Introduce yourself to the patient and explain the procedure
Confirm patient identity and obtained informed consent
Be aware of your workplace chaperones policy, patients are entitled to have someone with them. This may be a family member of member of staff
This test requires the patient to bare to the waist. This may be uncomfortable for women so offer gowns, paper towel to respect privacy and dignity makes sure doolrs are closed curtains are drawn ect.
Always think about infection prevention wash your hand use gloves and the appropriate PPE for the situation.

Question 5

Patient Preparation

Answer 5

Skin preparation is vital for an clear, accurate reading.

Several techniques you can use to ensure adequate contact between the electrode and the skin

Most obvious is chest hair thick chest hair will prevent adequate contact with the skin. May require shaving

Sweaty or oily skin may need wiping with a towel

Dry skin may need exfoliation

Patients should ideally be supine on bed however sometimes that isn’t safe or possible. For example wheel chair bound patients. The ech can be performed sat in a chair however positions will be inaccurate. Should be written on the printout that this was performed in this way.
There may be other scenarios in which you cannot place the stickers in the accurate positions such as dressings, broken skin or amputations. In these scenarios you should get as close to optimal positioning as anatomy will allow. The write on the ECG anything outside of normal practice.

There are certain situations in which altered positions are necessary. Briefly go over these however obtain advise if not comfortable