Section 6: ECG and Blood transfusion Flashcards
What is the purpose and use of ECG measurements?
An electrocardiogram (ECG) is a simple, non-invasive test that records the electrical activity of the heart muscle.
- Gram= recording
- Electro= of the electrical activity
- Cardio= of the heart’s muscle
An ECG canhelp diagnose certain heart conditions, including abnormal heart rhythms and coronary heart disease (heart attack and angina)
Indications for the use of a 12 lead ECG/when to use
- Suspect Arrhythmias
- Chest pain
- Pre-operative & postoperative assessment
- Routine health check
- Palpitations
- As part of a treatment pathway
- Upper abdominal pain
- Breathing problems
- Suspected cardiac condition
- History of dizziness
- Collapse and/or history of falls
12 Lead ECG- patient preparation
- Patient identification
- Communication+ informed consent
A chaperon is needed? An interpreter? - Patient position
45* Semi-Recumbent/flat (critically ill patients)
Patient needs to be relaxed
Expose chest
Any considerations for adults?
Any considerations for neonates and infants? - Skin preparation
Improper ECG lead placement and what this can cause
Improper placement of ECG leads can lead to significant issues, including misdiagnosis and inappropriate treatment. Here are some potential consequences:
- Misdiagnosis of Cardiac Conditions: Incorrect placement of leads can mimic or mask conditions like myocardial infarction (heart attack), arrhythmias, or bundle branch blocks
- False-Positive or False-Negative Results: For example, misplacement of the V1 or V2 leads can result in false-positive findings for conditions like anterior ST-segment elevation myocardial infarction
- Unnecessary or Delayed Treatment: Misinterpretation due to lead misplacement can result in unnecessary interventions or delays in providing the correct treatment
Consideration of patient history and symptoms when interpreting an ECG
Interpreting an ECG is not just about analysing waveforms; it requires a holistic approach that includes the patient’s history and symptoms. Here’s why this is crucial:
- Contextual Accuracy: Patient history, such as previous cardiac events, medications, or underlying conditions, can influence ECG findings. For example, a patient with a history of myocardial infarction may show Q waves, which could be misinterpreted without context.
- Symptom Correlation: Symptoms like chest pain, shortness of breath, or palpitations provide clues that help correlate ECG abnormalities with clinical conditions. For instance, ST-segment elevation in a patient with chest pain strongly suggests acute myocardial infarction.
- Avoiding Misdiagnosis: Some ECG changes, like T-wave inversions or arrhythmias, can occur in non-cardiac conditions (e.g., electrolyte imbalances or anxiety). Knowing the patient’s history helps differentiate between cardiac and non-cardiac causes.
- Guiding Further Investigation: A detailed history and symptom assessment can guide additional tests or interventions, ensuring timely and appropriate care.
Other special considerations to consider for ECG
Limbs Electrodes- special considerations:
- Amputations/tremors: move the electrodes up to the limbs
- Children: distraction method (play specialist, parents’ involvement…)
Precordial electrodes- special considerations:
- Breast tissue: V4, V5 and V6 should be placed underneath the breast, whilst V3 can be positioned over the breast tissue.
- Check ECG pre and post breast implant
Steps to take to ensure an accurate and effective ECG recording in an infant?
- First consider:
- Environmental control
- Movements/distraction
- Parental consent and information - Attach the electrodes to the limb and chest positionsas follows:
- Arm electrodes should be placed on the upper or lower arms, and SHOULD NOT be applied to the shoulders or clavicles.
- For total accuracy, arm electrodes should be attached to the wrists and leg electrodes to the ankles.
Antipsychotic medications and how this may affect ECG findings
- QT Interval Prolongation: Haloperidol, Sertindole, Pimozide can prolong the QT interval, increasing the risk of torsade’s de pointes, a potentially fatal arrhythmia.
- T-Wave Abnormalities: Some antipsychotics such as Clozapine may cause changes in T-wave morphology, which can be mistaken for ischemic changes.
- Sinus Tachycardia: A common side effect, particularly with atypical antipsychotics e.g., Clozapine
- Other Arrhythmias: Rarely, but Clozapine, Quetiapine & Olanzapine can lead to bradycardia or other conduction abnormalities.
Potential sources of artefacts on an ECG
- Patient Movement: Muscle tremors, coughing, or even brushing teeth can create artefacts that mimic arrhythmias.
- Electrode Issues: Loose or dry electrodes, or improper placement, can cause wandering baselines or erratic signals.
- External Interference: Electromagnetic interference from nearby devices can distort ECG readings.
- Lead Reversal: Misplacement of leads can result in abnormal waveforms that mimic pathological conditions
Common irregular ECG rhythms
Irregular ECG rhythms, also known as arrhythmias, can vary widely in their presentation and underlying causes. Here are some common types:
- Atrial Fibrillation (AFib): This is the most common irregular rhythm, characterized by rapid and disorganised electrical signals in the atria, leading to an irregular and often fast heartbeat.
- Atrial Flutter: Similar to AFib but with a more organised electrical activity, resulting in a “sawtooth” pattern on the ECG.
- Ventricular Tachycardia (VT): A fast rhythm originating from the ventricles, which can be life-threatening if sustained.
- Ventricular Fibrillation (VF): A chaotic rhythm in the ventricles that leads to ineffective pumping of blood and requires immediate medical intervention.
- Premature Atrial Contractions (PACs) and Premature Ventricular Contractions (PVCs): Early beats originating from the atria or ventricles, often felt as palpitations.
- Supraventricular Tachycardia (SVT): A rapid rhythm originating above the ventricles, often causing a sudden onset of palpitations.
- Heart Blocks: These include first-degree, second-degree (Mobitz I and II), and third-degree blocks, where the electrical signal is delayed or blocked as it travels through the heart.
Principle of Safe Blood Transfusion -
What are the key safety checks before and during a blood transfusion?
- Patient Identification: Always verify the patient’s identity (name, date of birth) before starting the transfusion.
- Blood Compatibility: Ensure that the correct blood type is given to avoid reactions.
- Monitoring: Observe the patient closely for any signs of a reaction during and after the transfusion.
- Communication: Encourage the patient to ask questions and report any discomfort or unusual symptoms
What are the common reasons a patient may need a blood transfusion?
(Indication for blood and blood product transfusion)
- Shortage of red blood cells
- Body not producing enough red blood cells
- Severe bleeding – usually from surgery, childbirth or a serious accident.
- Conditions that affect the way your blood cells work: Sickle cell disease or thalassaemia
- A type of cancer or cancer treatment that affects red blood cells: Leukaemia, chemotherapy or stem cell transplants
- Blood transfusion can replace lost blood, or just replace the liquid of cells found in blood: red blood cells, plasma or cells called platelets.
What key considerations should be discussed with a patient before obtaining consent for a blood transfusion?
- Reasons for the transfusion and consent
- Risks and benefits
- The transfusion process and field considerations
- Any transfusion needs specific to the patient
- Any alternatives that are available, and how they might reduce the need for a transfusion
- The patient is no longer eligible to donate blood
- The patient should be encouraged to ask questions.
- Document discussions in the patient’s notes
What are the blood administration protocols?
- Adhere to guidelines for safely administering blood.
- Always use an infusion pump or gravity drip set to administer the blood.
- Do not infuse blood with other medications or fluids unless specified
Record the time, volume, and rate of transfusion
How is the patient monitored during blood transfusion?
- Prior to the blood transfusion administration, base line observation should be performed.
- Regularly check vital signs (temperature, pulse, blood pressure) refer to trust protocol
- Monitor for signs of transfusion reactions (e.g., fever, chills, rash, dyspnoea).
- Be prepared to stop the transfusion immediately if a reaction occurs.
How is the patient monitored after blood transfusion?
- Monitor for delayed reactions such as haemolytic reactions, infections, or iron overload.
- Perform blood tests to assess effectiveness (e.g., haemoglobin, platelet count).
- Document transfusion details and reactions, if any.
What are the possible adverse reactions to a blood transfusion?
- Allergic reaction: Skin rash, itching or hives
- Fever: Mild or moderate temperature increase
- Haemolytic reaction: Destruction of red blood cells, leading to pain and dark urine
- Febrile non-haemolytic reaction: Fever with chills but not relate to blood cell destruction
- Transfusion-related acute lung injury (TRALI) Respiratory distress shortly after transfusion.
What steps should be taken to ensure a safe blood transfusion for a child?
- Patient Identification – Confirm the child’s identity (name, DOB, wristband) against medical records and the blood bag.
- Blood Compatibility – Lab tests determine blood type and crossmatch to ensure donor compatibility.
- Storage & Preparation – Verify blood storage conditions (1–6°C), expiration date, and integrity before use.
- Administration Protocol – Follow doctor’s orders, use sterile equipment, and infuse blood slowly via an infusion pump without mixing with other fluids/medications.
- Monitoring During Transfusion – Check vital signs every 15 minutes for early reactions.
- Post-Transfusion Monitoring – Observe for 30 minutes after transfusion, assess haemoglobin levels, and document findings.
- Emergency Protocols – Educate parents on delayed reaction signs (fever, rash, swelling) and provide emergency contact details.
- Documentation & Reporting – Record all transfusion details for traceability; report if any reaction occurs.
Why is blood transfusion needed?
- To replace blood components such as rbc, plasma, platelets
- To treat blood disorders
- To improve oxygenation
