15 lead ecg training pp
TRANSCRIPT
BASE HOSPITAL GROUPONTARIO
Chapter 8 for 12 Lead Training
-The 15 Lead ECG-
Ontario Base Hospital GroupEducation Subcommittee
2008
TIME IS MUSCLE
OBHG Education Subcommittee
The 15 Lead ECG
REVIEWERS/CONTRIBUTORSNeil Freckleton, AEMCA, ACPHamilton Base Hospital
Jim Scott, AEMCA, PCPSault Area Hospital
Ed Ouston, AEMCA, ACPOttawa Base Hospital
Laura McCleary, AEMCA, ACPSOCPC
Tim Dodd, AEMCA, ACPHamilton Base Hospital
Dr. Rick Verbeek, Medical DirectorSOCPC2008 Ontario Base Hospital Group
AUTHORGreg Soto, BEd, BA, ACPNiagara Base Hospital
OBHG Education Subcommittee
Chapter 8 - Objectives Describe the benefits of acquiring a 15-lead
ECG Describe the proper lead placement for
Leads V4R, V8, and V9 Describe the hemodynamic problems
associated with a right ventricular infarction List 3 clinical signs of RVI On a 15-lead ECG, recognize ECG
changes for a posterior and right ventricular MI
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Why a 15-Lead ECG?
Used when a patient has an Inferior STEMI or suspected Posterior STEMI (reciprocal changes with ST depression in V1/V2)
Can confirm Posterior MI (usually associated with an Inferior MI
Can suggest RVMI which is a larger and more complicated Inferior MI
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Acquiring the 15-Lead (V4R)
Run standard 12-lead Lead V4R: 5th IC
space midclavicular on right side
Same as left side V4 Attach V4 wire to the
V4R position
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Acquiring a 15-Lead (V8, V9) Posterior leads V8: 5th IC space
midscapular line V9 goes between V8
and the spine Place Lead V5 wire on
V8 and V6 wire on V9 Acquire the second 12-
lead Re-label the new leads
Note: A 16-lead ECG can also be utilized to examine the posterior myocardium, and differs from the 15-lead ECG in that V4 becomes V7.
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Right Ventricular Infarction RV gets blood supply from the RCA Up to 50% of inferior MI will have RVI RV is preload dependant for Cardiac Output Nitrates cause preload reduction; thus use
nitrates with extreme caution Hypotension in RVMI often responds well to
IV fluid bolus (increase in preload) May require 1 liter or more IV fluid bolus for
hypotension
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Clinical Signs of RVI
The TRIAD: Jugular vein distention (JVD) Hypotension, either presenting or
following nitro administration Clear lung sounds
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Right Coronary Artery
Inferior wall of LV Right ventricle Posterior LV Posterior fascicle
of LBB SA and AV node 2nd deg I common
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Posterior view
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15-Lead ECG
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15 Lead Practice Cases
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Inferior/Posterior/RVI
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Inferior
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Inferior - Posterior
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None
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Inferior/Posterior
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None
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Indications - 15 Lead ECG
Any Inferior AMI (but especially accompanied by ST-depression in V1 to V3)
ST-depression in V1 – V3 on its own in symptomatic ACS patient
BASE HOSPITAL GROUPONTARIO
QUESTIONS?
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Well Done!
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START QUIT