PowerPoint 3 Flashcards
9 steps for patient positioning for electrode placement?
-Place patient in a supine position ifthe patient will tolerate.
-Place the patient’s arms down by their side to relax their shoulders.
-Patient’s legs should be uncrossed.
-Electrical devices such as mobile phones should be away from the patient as these devices may interfere with the machine.
-Dry the skin if it is moist.
-Shave any hair that can interfere with electrode placement.
-Electrode gel should be moist.
-Electrodes should not be placed over bones and over areas where there is a lot of muscle movement.
-Sometimes an abrasive material such as a wash cloth may need to be used to remove dead skin cells.
Placement of the first 4 electrodes?
-Also Known as Limb Leads
-Equal Bilateral Placement
-Be consistent with spacing
-Not over bone
V1?
4th intercostal space to the right of the sternum
V2?
4th intercostal space to the left of the sternum
V3?
Midway between V2 and V4
V4?
5th intercostal space at midclavicular line
V5?
Anterior axillary line at the same level as V4
V6?
Mid axillary line at the same level as V4 and V5
What to watch out for when collecting data?
Have patient lie still with normal breathing
Check monitor for electrical “noise”
Click Record for at least 6 seconds
Print findings
How is a 12-lead ECG organized?
I aVR V1 V4
II aVL V2 V5
III aVF V3 V6
Eight steps to ECG interpretation?
-Determine regularity of rate/rhythm
-Heart rate calculation
-P wave location and exam
-PR interval measurement
-QRS complex measurement
-Identify abnormal Q waves
-Evaluate ST segment and T wave
-Axis deviation
What to do in step 1: determine the regularity of rate/rhythm?
Tick Mark Method
Start far Left. Put paper over ECG aligning R waves
Mark Tall tick marks above 1st and 2nd R waves
Move paper right and do smaller tick marks
Measure the distance between the ticks from 1st to second
3 small boxes or more of variation (.12sec) is considered irregular HR
What to do in step 2: heart rate calculation?
Regular rhythm method
# small boxes between 2 Rwaves / 1500
Dark Line Method
Irregular rhythm Method
6 sec rhythm strip: # of R waves x 10
3 sec rhythm strip : # of R waves x 20
What to do in step 3: P wave location and exam?
L3- I method (Look, Locate, Learn, and Interpret)
Look: Find the P wave. Star it!
Locate: # of P waves over 6 sec strip
Learn : P wave is the same size, location, shape and consistent = proper depolarization of Atria
If not same size, location, and shape = abnormality
Interpret: write down what you see! On ECG paper
What to do in step 4: interval measurement?
Measure beginning of P wave to beginning of QRS complex
# of small boxes x .04
Normal = 0.12- 0.20sec ( 3-5 small boxes)
Do more than one to check for consistency
What to do in step 5: QRS complex measurement?
Beginning of QRS complex to ST segment
# of small boxes x 0.04
Normal QRS is < 0.10ms ( 2.5 small boxes)
Also check shape
rSR’complex
What to do in step 5: identify abnormal Q waves?
Look for Q waves that don’t belong in the anterior and Inferior leads
> 2mm in lateral leads
What do do in step 7: evaluate ST segment and T waves?
ST segment should be isoelectric.
Evaluate for depression or elevation.
T waves should follow the direction of the QRS complex.
Assess T waves for polarity and amplitude (direction and size).
What will the leads look like for LAD?
QRS complex in lead I is positive
QRS complex in lead aVF is negative
Left axis deviation is present
What will the leads look like for RAD?
QRS complex in lead I is negative
QRS complex in lead aVF is positive
Right axis deviation is present
What will the leads look like for a normal axis deviation?
QRS complex in lead I is positive
QRS complex in lead aVF is positive
What will the leads look like for extreme axis deviation?
QRS complex in lead I is negative
QRS complex in lead aVF is negative
What are the inferior leads?
II, III, and aVF
What are the lateral leads?
I, aVR, AVL, V5, V6
What are the anterior leads?
V3 and V4
What are the septal leads?
V1 and V2
