Optional or Required, EMT & AEMT

EKG 12-lead Data AcquisitionEKG 12-lead Data Acquisition

Course Objectives1) Define purpose of 12-lead 2) Know the indications for 12-lead3) Describe the procedure for application4) Describe the procedure for obtaining 12-

lead information5) Understand complications of 12-lead 6) Understand transmission of 12-lead data7) Know how to document 12-lead data

Purpose of EKGElectro Cardio Gram (ECG or EKG) allows us to

see the electrical activity of the heartTrained professionals are able to interpret

rhythmEKGs allow for determining possible:

Heart arrhythmiasSites of heart attacksHeart abnormalities

Indications for 12-leadChest pain, or any anginal symptomsRespiratory problemsOverdoseStrokeHeart arrhythmiasResuscitationThere are no contraindications

So use when ever you may think it appropriate

Application of 12-lead12-lead consists of 10 electrodes Electrode placement is important

Electrodes view heart from different directions12-lead shows 12 different leads

Leads I, II, III, aVr, aVl, aVf, and V1-V6Placement locations

4 limb leads (RA, LA, RL, LL)6 leads across chest (V1, V2, V3, V4, V5, V6)

Placement of electrodesAvoid hair and thick muscle mass (trim hair if needed)Cleanse site with alcohol to remove dirt and oilThen attach

Limb LeadsEach limb has a

leadLeads can also

be moved in to shoulders and abdomen

Electrodes should be placed on inside of limbs

Chest (precordial) leadsV1- 4th intercostal space

on right sternal borderV2- 4th intercostal space

on left sternal borderV3- Between V2 & V4V4- 5th intercostal space

@ midclavicular lineV5- level with V4 @ left

anterior axillary lineV6- level with V5 @

midaxillary lineRemember to respect

modesty as best as possible

Obtaining the 12-leadBest to do before leaving, if practicalOnce electrodes are on:Turn monitor onPush 12-lead buttonInput information that it asks for (age)12-lead will then startPrint 2 strips

One for ER upon your arrivalOne for your documentation

Transmit 12-lead (if applicable to your service)

This is a normal adult ECG

82 year old lady with dizzy spells

Atrial fibrillation and complete heart block

ComplicationsPatient movement can affect readings

Ask patient to hold as still as possibleLoose electrodes will either not show

readings, or alter themCheck electrodes

Moving ambulance affects readingsDo before leaving or when stopped

Loud noise Do everything you can to minimize noise

TransmissionPurpose:

Saves time in ER for serious patients, they can get to advanced care more quickly

Allows hospital to compare current ECG with previous 12-leads of the patient while you are still enroute Physician can compare changes that occurred during

your transport

Best to do when patient is in pain, signs may not be present on ECG during non-pain

Transmitting basicsEach monitor is slightly different in operation

and transmission optionsIn general:

Hospital needs to be set up to receive transmission 12-leads can be sent to a computer, fax, PDA, etc.

Ambulance needs transmitting device (cell phone, radio, Bluetooth, etc.)

Once all leads are placed, obtain 12-lead, then transmit according to set up

Documenting Your 12-lead12-lead data should be included in patient

care reports for every patient that receives one

Should include:Copy of the 12-leadTime 12-lead was obtainedInformation about transmission (successful?)

If 12-lead was not obtained, but should have been, document reason not obtained

Videos• The Videos below give a good general

overview of 12-leads.• Video on application

• 12 Lead ECG Placement Part I• http://www.youtube.com/watch?v=eA5HmQSMGHE

• Video on trouble shooting• 12 Lead ECG Placement Part II• http://www.youtube.com/watch?v=TFcyiCKyaZ4

Skill OverviewIn the skills station you will be required to:

Do initial assessmentEstablish patient is a candidate for 12-leadPlace electrodes properly Acquire 12-lead and print 2 copiesDescribe transmission and documentation Transport patient

SummaryPurpose of the 12-lead is to see electrical

activity of heart and help diagnose heart problems

Indications include: chest pain, overdoses, strokes, respiratory problems, etc.

10 electrodes are placed on the body with 4 limb leads and 6 chest leads

12-lead is obtained by pushing the 12-lead button on the monitor and inputting information asked for

Summary cont.Complications can include: movement, loose

electrodes, and noiseTransmission is done after obtaining the 12-

lead and uses a transmitting device and a receiving device at the hospital

The 12-lead is documented with a copy of the 12-lead and the time it was obtainedAttach it to the patient care report