15 lead ecg training pp

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

BASE HOSPITAL GROUPONTARIO

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?

BASE HOSPITAL GROUPONTARIO

Well Done!

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