2015 Trumbull Memorial Hospital Demo

12 Lead ECG

12 Lead ECG

Steps

Performed? Yes No

1. Prepare ECG monitor and connect patient cable with electrodes.

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2. Enter the required patient information into the 12-Lead ECG device.  First and Last Name  Date of Birth  Age  Gender  Cardiologist (if able to enter)

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3. Expose chest (respecting modesty) and prep as necessary. Poor quality can be caused by lack of skin preparation. Use a gauze pad to vigorously rub the site, to remove the outer layer of dead skin. Dry the site. Alcohol preps can remove creams or lotions. Remove excess hair as needed. 4. Attach limb leads on or near the limbs. Avoid attaching to the torso. Attaching leads to the torso produces a cleaner rhythm, but may limit evaluation of ECG. Some changes that may occur are:  Cardiac axis shift to the right  R wave becomes smaller in Lead I  Less prominent Q waves in inferior leads

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5. Apply chest leads and extremity leads using the following landmarks:

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 V2 – 4 th ICS at sternal border  V3 – Directly between V2 and V4  V4 – 5 th ICS at midclavicular line  V5 – Level with V4 at anterior axillary line  V6 – Level with V5 at midaxillary line

 RA – Right arm  LA – Left arm  RL – Right leg  LL – Left leg  V1 – 4 th ICS at sternal border

6. Instruct patient to remain still.

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7. Press the appropriate button to acquire the 12-Lead ECG.

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8. If the provider is an EMT or AEMT without a Paramedic present, transmit the 12-Lead. If a Paramedic is present and the 12-Lead shows STEMI or a life threatening arrhythmia, transmit to the receiving facility.  If the Paramedic identifies a STEMI, activate the cath lab by calling the receiving facility and identifying your unit, then stating “I have a STEMI.” Then explain the situation,

including the leads with ST elevation, and verbally activate the cath lab. 9. If the tracing displays too much artifact, consider the following:

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 Check cable connection  Is the equipment functioning properly?  Is there interference from external electrical equipment?  Are the electrodes dry?

 Is there poor adhesion?  Are the cables touching a metal surface?  Are the cables entangled or hanging?  Is the snap connection secure?

10. Monitor the patient while continuing with the treatment protocol.

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112

EMR

EMT

AEMT

Paramedic

Extended