ECG practical

What is the first step of skin preparation?

Locate/label the ten electrode placement sites. If necessary, shave hair off at the locations

What is the Second step of skin preparation?

Abrade the skin at the electrode placement sites with ECG prep tape (or a fine cotton pad or gauze with exfoliating gel) to remove surface epidermis -this will reduce extraneous electrical noise (interference and skeletal muscle artifact)

What is the Third step of Skin preparation?

Wipe the abraded areas with an alcohol wipe to remove oil and lose epidermis

What is the 4th step of skin preparation?

Wipe areas again but with a clean rag or gauze to remove any moisture/alcohol. The skin should appear red, slightly irritated, dry, and clean

What is the 5th step of skin prep?

Lastly, place the ten electrodes on the abraded and clean areas, and then connect the ECG machine cables to the electrodes

RA

Place at the midway point under the right clavicle.

LA

Place at the midway point under the left clavicle.

RL

Place above the right iliac crest (top of right pelvis); in the mid-clavicular line

LL

Place above the left iliac crest (top of right pelvis); in the mid-clavicular line

V1

Place within the 4th intercostal space towards the right of the sternum

V2

Place within the 4th intercostal space towards the left of the sternum

V3

Place between V2 and V4; near or right above the xiphoid process

V4

Place below left pectoris, roughly within the 5th intercostal space; is below and slightly leftward from V2; in the mid-clavicular line

V5

Place to the left of V4; roughly within the 5th intercostal space; in the anterior axillary line

V6

Place to the left of V5; roughly within the 5th intercostal space; in the mid-axillary line

Absolute indicators

ST-segment elevation in Leads without pre-existing Q-waves b/c of prior MI (other than aVR, aVL, or V1)

sustained V tach

V fib

agonal

accelerated idoventricular rhythm

2nd degree AVB

3rd degree AVB

relative indicators

ST segment downsloping depression >2mm

ST segments horzontal depression >2mm

arrhythmias other than sustained V tach

development of bundle branch block that cannot be distinguished from V tach

V Fib

squiggly lines

rate jumps up and down

V tach (high rate)

Rate stays at 185 bpm

V tach (low rate)

rate stays at 140 bpm

T de P

rate is high

A fib

rate between 140-159 bpm

A flutter

rate stays at 151 bpm

PSVT

Rate jumps from 200+ to under 100 bpm

sinus tach with ST depression

rate at 120 bpm

NSR with anterior MI

rate at 72 bpm

2nd degree type 1 AVB with lateral ST elevation

rate 40-49 bpm

sinus brady with inferior MI

rate at 40 bpm

1st degree AVB with RBBB

rate at 60

look at v1-3

2nd degree type 2 LBBB

rate 40/48

look at v5-6

3rd degree AVB

rate at 37 bpm