CCMA EKG Review (NHA)

Type of room to be used for EKG

quiet room without electrical equipment

Information needed from pt. for EKG

medical history, name, gender, age, medications list (date and time of EKG)

What are the 7 things you should inform the pt. of before an EKG?

1. no pain

2. empty bladder 10 minutes before

3. wear loose clothing

4. rest for 30 mins. before

5. test only lasts 5 minutes

6. will need to access upper arms and lower legs

7. breath normally and remain still

pt. positioning for EKG

supine or semi-fowler's

RA/white lead

right arm, tab faces upper arm

LA/black lead

left arm, tab faces upper arm

RL/green lead

right leg, tab faces upper leg

LL/red lead

left leg, tab faces upper leg

V1/red

4th intercostal space, right sternal

V2/yellow

4th intercostal space, left sternal

V3/green

halfway between V2 & V4

V4/blue

5th intercostal space, left midclavicular line

V5/orange

horizontal line with V4 at anterior axillary line

V6/purple

horizontal line with V3 at midaxillary line

Holter monitoring has 3-channel and what type of lead monitors?

either a 7-lead or 5-lead monitor

During a stress test, if an emergency occurs you should:

stop the test and get the patient to a safe position and perform CPR if necessary

Holter Ambulatory Monitor

pt. wears for 24 hours and logs all cardiac activities, which include stress, physical activities, and emotions

T/F: During Holter Ambulatory Monitoring, patients may not shower

True

During Holter Ambulatory Monitoring, patients are to seek medical attention if they experience the following symptoms:

SOB, chest pains, dizziness

3 ways heart rate is measured by EKG

1. 1500 method

2. sequence method

3. 6-second rule

1500 method outline

count # of boxes between PP or RR interval and divide by 1500

1500 method is good for

fast rhythms

PP

atrial rate

RR

ventricular rate

sequence method outline

estimates HR based on #5mm boxes in QRS complex by assigning first R wave "300" and then for every subsequent 5mm box, assign (in the following order): 150-100-75-60-50. The closest number that the next R wave falls onto is the ventricular rate.

6-second rule

"Golden standard" and good for any situation

6-second rule outline

small marks at the top of the print out indicate 3-sec interval, count the # of QRS complexes in 2 sections and multiply by 10

Patient-caused artifacts are often due to:

seizures, trembling, moving, shivering, fast breathing and overly dry or wet skin

Electrodes with _ gel are never to be used

dry

A wandering baseline can be corrected by

completing skin contact by wiping away lotions, asking patient not to move as much and correcting placement

T/F: Activity from a seizure should be recorded.

False, seizure activity should be controlled prior to tracing

Two groups that require right-sided 12-lead EKG are

patients less than 8 y/o and STEMI

Standard EKG's have

12 leads and are left-sided

5 steps to measure a patient's heart rhythm from EKG tracing

1. calculate heart rate, both atrial and ventricular

2. measure PR interval

3. measure QRS duration

4. determine regularity

5. interpret

Difference between Holter monitor and Ambulatory telemetry?

Holter is worn for 24-48 hours, Ambulatory telemetry cam be worn for as long as 30 days.