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ECG 1 procedure ECG.pptx

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ECG 1 procedure ECG.pptx

  1. 1. Mdm Rozila Ibrahim July 2022 TECHNIQUE TO DO 12 LEAD ECG
  2. 2. OUTLINE • What is 12 lead ECG • Purpose of doing 12 Leads ECG • Indications • Contraindications • Components of ECG machine • Item preparation • How to perform ECG • How to minimize interference • References 30/11/2022 Rozila Ibrahim july 2022 2
  3. 3. ECG 30/11/2022 Rozila Ibrahim july 2022 3
  4. 4. 30/11/2022 Rozila Ibrahim july 2022 4
  5. 5. 30/11/2022 Rozila Ibrahim july 2022 5
  6. 6. 12 LEADS ECG 30/11/2022 Rozila Ibrahim july 2022 6
  7. 7. WHAT IS 12 LEAD ECG •12 lead ECG is the representation of the heart’s electrical activity. •Sees heart from 12 different view. •Placed on patient’s skin and on the surface of chest. •Electrodes are conductive pad in contact with the body. 30/11/2022 Rozila Ibrahim july 2022 7
  8. 8. WHAT IS 12 LEAD ECG • Consists of : - 3 standard limb leads (bipolar) - 3 augmented limb leads (unipolar) - 6 precordial chest leads (unipolar) *Electrocardiogram Augmented Limb Leads (Unipolar) These are termed unipolar leads because there is a single positive electrode that is referenced against a combination of the other limb electrodes. * The positive electrodes for these augmented leads are located on the left arm (aV L ), the right arm (aV R ), and the left leg (aV F ). 30/11/2022 Rozila Ibrahim july 2022 8
  9. 9. BIPOLAR AND UNIPOLAR LIMB LEADS 30/11/2022 Rozila Ibrahim july 2022 9
  10. 10. PRECORDIAL LEADS 30/11/2022 Rozila Ibrahim july 2022 10
  11. 11. EINTHOVEN’S TRIANGLE 30/11/2022 Rozila Ibrahim july 2022 11
  12. 12. PURPOSE OF DOING 12 LEAD ECG •Identify primary conduction abnormalities (cardiac arrhythmias, cardiac hypertrophy, pericarditis, electrolytes imbalance, ischemic changes and myocardial ischemia site and the extent of myocardial infarction). •Monitoring recovery from MI. •Evaluate effectiveness of cardiac medication. •Asses Pacemaker performance. •Determine effectiveness of thrombolytic therapy. •Baseline pre operative assessment. 30/11/2022 Rozila Ibrahim july 2022 12
  13. 13. INDICATIONS •Chest pain, epigastric pain •Back, neck, jaw or arm pain without chest pain •Palpitations •Syncope or near syncope •Exertional dyspnea, weakness •Diaphoresis •Feel anxiety •Electrolyte imbalance •Sign of tachycardia, bradycardia, shock 30/11/2022 Rozila Ibrahim july 2022 13
  14. 14. CONTRAINDICATIONS Burn patient •DO NOT use ECG bulbs. •Use ECG patch. 30/11/2022 Rozila Ibrahim july 2022 14
  15. 15. CONTRAINDICATIONS •Patients allergies of sensitivity to the ECG patch or the electrode gel •Patient refuse •No absolute contraindication to 12 Lead ECG 30/11/2022 Rozila Ibrahim july 2022 15
  16. 16. COMPOMENTS OF ECG 30/11/2022 Rozila Ibrahim july 2022 16
  17. 17. ITEMS 30/11/2022 Rozila Ibrahim july 2022 17
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  22. 22. 1. Ensure the patient is reclined in a comfortable resting position 2. Use A High Quality ECG Electrode 3. Ensure The Correct Electrode Placement 4. Record In A 4 x 3 Format 5. Record Any Clinical Signs During The Procedure 6. Remove The Electrodes After Use 30/11/2022 Rozila Ibrahim july 2022 22
  23. 23. BEFORE ECG PROCEDURE PREPARATION OF EQUIPMENT •Machine is charged and ready to use. •It should be stock with sufficient paper for recording, tissues and clinical wipes. •Cable is attached firmly and no frayed, broken or bare cable wire. 30/11/2022 Rozila Ibrahim july 2022 23
  24. 24. BEFORE ECG PROCEDURE SKIN PREPARATION •Dry the skin if moist or diaphoretic - Alcohol swab to remove excess skin oil - Clip or shave excess hair - Abrade dead skin with skin prep tape - Check lead wires for damage/wear - Ensure leads are not dried out - Promote an environment that prevents the patient from sweating profusely. 30/11/2022 Rozila Ibrahim july 2022 24
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  26. 26. BEFORE ECG PROCEDURE •Ask patient to remove/ loosen jewelleries and undergarment. •Patient’s arm should be lying flat at each side, relax the shoulders and keep legs uncrossed. •If the bed did not fit comfortably with patient, ask patient to cross his arms on his stomach to reduce muscle tension and movement. •Instruct patient to lie still and quietly and to breathe normally until the test is done. •Place a cover over the chest area. 30/11/2022 Rozila Ibrahim july 2022 26
  27. 27. DURING ECG PROCEDURE •Select flat ,fleshy areas to place limb electrode. •Avoid muscular and bony area. •If patient has amputated limb, choose a site on the stump. 30/11/2022 Rozila Ibrahim july 2022 27
  28. 28. DURING ECG PROCEDURE •Place electrodes correctly. •Placement as follows: - V1 – 4th intercostal space on the RT sternum - V2 – 4th intercostal space on the LT sternum - V3 – Midway between V2 and V4 - V4 – 5th intercostal space at the mid clavicular line - V5 – Anterior axillary line, same horizontal level of V4 - V6 – Mid axillary line , same horizontal level as V4 and V5. 30/11/2022 Rozila Ibrahim july 2022 28
  29. 29. 12 LEADS ECG PLACEMENT 30/11/2022 Rozila Ibrahim july 2022 29
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  31. 31. Placement of Limb leads 30/11/2022 Rozila Ibrahim july 2022 31
  32. 32. •Record an ECG: - Turn on ECG machine. - Calibrate to 10mm/mV. - Rate at 25mm/s. - Enter ID. - Record and print. •Remove the electrodes and clean patients skin •CLEAN and DRY the electrodes •Assist patient to a comfortable position •Put away ECG machine in equipment room, charge. 30/11/2022 Rozila Ibrahim july 2022 32
  33. 33. HOW TO MINIMIZE INTERFERENCE 30/11/2022 Rozila Ibrahim july 2022 33
  34. 34. •Cause of artifact/ interference: - Contact (skin, leads, faulty wires) - Movement (Patient, cable, vehicle) •Ensuring good contact. •Prevent patient movement. - Check for subtle movement. - Look for muscle tension. - Coach/instruct the patient. 30/11/2022 Rozila Ibrahim july 2022 34
  35. 35. HOW TO MINIMIZE INTERFERENCE •Prevent cable movement. •Switch off non essential electrical devices and equipment within the vicinity if possible. •Check for cable loops and avoid running cable adjacent to metallic objects •Inspect wires and cable for cracks or breaks. Replaced as needed. •Ensure securely connection between patient cable and the ECG device. 30/11/2022 Rozila Ibrahim july 2022 35
  36. 36. REFERRANCE 1. European Heart Journal (2010) 31, 243–259 doi:10.1093/eurheartj/ehp473. 2. Understanding 12leads ECG, Nursing 2018. 3. Utility of the Pre-Hospital 12 Lead ECG, Dr. Mike Lewell, Dr. Matthew Davis (November 4, 2011) 30/11/2022 Rozila Ibrahim july 2022 36
  37. 37. Thank you 30/11/2022 Rozila Ibrahim july 2022 37

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