EKG Certification Module 2: Acquisition

Pericardium

outermost layer, sac containing heart

myocardium

middlelayer

endocardium

innermost layer

Locate tricuspid valve

inbetween R atrium and Ventricle

locate pulmonary valve

in between right atrium and lungs

locate bicuspid valve

inbetween Left atrium and ventricle

locate aortic valve

in between left ventricle and aorta

where do coronary arteries originate

root of the aorta

what does occlusion of a LAD cause

ventricular arrhythmia and leads to death

what are the three pacemakers of the heart IN ORDER

SA Node, AV Node, Purkinjie Fibers

SA node heart rate

60-100

AV node heart rate

40-60

Purkinjie Fibers heart rate

20-40

measurement of the small box on EKG strip (LxW)

1mm by 1mm

1 big box equals how many small boxes

5

how much time equals the length of a small box (1mm)

.04 seconds

standard speed on a EKG

25mm/sec and 10mm/mV

if pt is tachy what do you need to change

increase EKG speed to 50 mm/sec

standard EKG Amplitude/Gain

10 mm/1mV

standard caliberation cause what

positive deflected rectangular shaped marker

measurement of standard marker (LxW)

10mm by 5mm

if EKG waveforms are to small to read…

set amplitude to 20mm/mV

children usually have large waveforms, if to big to see…

set amplitude to 5mm/mV

which way must the pt wear the gown

opening to the front

how is a pt positioned for a EKG

supine

why would a pt be in a semifowler position

if pt has orthopnea, respiratory conditions,late pregnancy stages, or cardiac problems

if a pt has tremors what do you do

place hands palm down under the hips

for pt in later pregnancy stages what do you do

place a cushion under the right hip to tilt pt slightly left

how to set a pt for stress testing

standard 12 lead EKG, limb leads on torso, and BP cuff on arm

12 Lead V1

4th ICS right of sternum

12 lead V2

4th ICS across from V1

12 lead V3

midway between V2&4

12 lead V4

5th ICS midclavicular

12 lead V5

5th ICS midway between V4&6 anterior axillary line

12 lead V6

5th ICS midaxillary line

12 lead Right Arm

wrist, white

12 lead Left Arm

wrist, black

12 lead Left Leg

red, ankle

12 lead Right Leg

green, ankle

Ambulatory White Lead

right sternal border 1st rib

Ambulatory Red Lead

right sternal border 3rd rib

Ambulatory black lead

left anterior axillary line 5th rib

Ambulatory Brown Lead

left sternal border 1st rib across from white lead

Ambulatory green Lead

right lower thoracic area anywhere in the rib cage

3-Lead White

right shoulder just beow the clavicle

3-Lead black

left clavicle/shoulder area

3-Lead Red

below left pectoral muscle at apex of the heart

Stress Testing White

right clavicle/shoulder area

Stress Testing Black

left clavicle/shoulder

Stress Testing Red

left lower abd.

Stress Testing Green

right lower abd.

Telemetry White

right shoulder

Telemetry Black

left shoulder

Telemetry Red

lower left abd.

why would a pt require a right sided EKG

if pt has cardiac conditions, dextrocardia, and if pt is younger than 8

EKG Tech responsiblities

demographic data is accurate, leads properly attached, and clear of artifacts

what is positive deflection

leads are attached to correct limbs

what is negative deflection

leads aren't attached properly

what is a wandering baseline artifact

EKG tracing going up and down like hills

what causes a wandering baseline

improperly lead placements, movement of leads/cables, pt movement, loose electrode, dry electrodes, has pt labored breathing, improper skin prep

how to avoid wandering baseline

clean skin of any residue, free it of any topical substances, educate pt on what's happening, give clear info on breathing

whats a somatic tremor artifact

muscle movement on EKG tracing

what's a AC interference artifact

electronic devices causing disturbance near or on the pt

how to avoid AC Interference

turn off and remove all electronics near the pt