Final Considerations for EKG

Protected Health Information

Protected Health Information

Don’t forget that when dealing in any health care scene, to protect the patient's privacy!

• • PHI - Protected Health Information

• Disclosing health information is a breach of patient confidentiality.

HIPAA

Health insurance portability and Accountability Act

Consent

Don’t forget consent! Implied consent counts if the patient is waiting on the table in a gown but still explain what you are doing!

Medical Asepsis

The clean technique

• Make sure you are clean when setting up a EKG

• Follow proper work clothing protocols

• Always wash your hands as well as the location the patient will be laying (protect spread/chain of infection)

Patient Communication

When the patient walks into the room,

1. Make sure you make eye contact, face the patient, and repeat and clarify anything the patient may have questions about

2. Ask them to state their name and date of birth, this double check the patient as well as informs you of any disabilities they may have

3. Explain the procedure

Display Professionalism

Details include physical appearance, eye contact, and displaying an understanding and knowledge of the situation (increase patients’ confidence)

Active Listening Skills

Recognizing messages that are being sent through both verbal and nonverbal methods (body language and facial expressions)

Skilled Interview Techniques

Ask patients a variety of open-ended questions that encourage them to provide detailed information (“What medications do you currently take? & “Describe any chest pain or symptoms are experiencing.”) Open communication & provide a broader picture towards ensuring proper care can be delivered.

Provide Empathy

Avoid jumping to conclusions or passing judgments (be empathetic and provide encouragement).

Practice collaboration

Patients are more likely to respond positively to recommendations and questions in collaborative settings - communication is more effective and overall care improves.

Embrace Technology

Technology provides health care professionals many ways to communicate with patients, but DO NOT OVERWHELM THE PATIENT! Only use no more than three communication channel, and if a patient is only comfortable with one, provide communication via that method.

Communication

• Make sure you are not only communicating with your patient, but also with your team

• Ensure the health care provider is up to speed with the patient

• Make sure to properly document through safe and private means of communication: Electronic Health Records, Verbal Exchange, and Encrypted Work Chats

Vital Signs

• When measuring an adult HR, measure the radial pulse for day to day, carotid for emergencies.

• When measuring a child, use the brachial site.

• Children (3-5) HR are 80-120 normal.

Gather the history of

1. Social: Smoking, drinking, stress, exercise

2. Medical: Past history, medical conditions, current symptoms

3. Surgical: Past surgeries

4. Medication: What medications do they take

Preparing the patient

• Patients disrobed from waist up with access for leg lead placements

• Tights should be removed

• Jewelry should be removed, same with electronic devices, such as watches and cell phones

• Depending on the type of EKG the patient is there for, ensure proper educations on the test

EKG

• Patient is placed in a supine position

• Uses 10 electrodes

• Takes the LEAST amount of time to complete

Stress test

• Requires blood pressure checks throughout the procedure

• Use of a treadmill or stationary bike

• Goal of raising the heart rate

Ambulatory Monitoring

• Also known as Holter monitor

• Patient has to document events

• Uses 3 to 5 electrodes

• Monitors over a period of time (NO WATER CONTACT)

Check the patient for

• Tachycardia or bradycardia

• Pallor

• Diaphoresis

• Low blood pressure

• Fast/labored/shallowed/slow respirations

• Anxiety or confusion

• Cyanosis

• Chest pain that radiates to back, arms, or jaw

• Chest tightness (squeezing sensation)

• Shortness of breath

• Nausea and vomiting

• Lightheadedness

• Weakness

• Syncope (EMERGENCY HELP NEEDED)

Channels

3 channels records 3 leads aka 3 EKG readings at once (single channel records one lead)

Preparing the EKG

What you need:

1. EKG machine

2. Power Source

3. Electrodes

4. Leads with clips or connectors

5. EKG graph paper (if not digital)

6. Alcohol wipes

7. Gauze pads

8. Scissors and razors

9. Pillows, blankets, and gowns

12-lead EKG Positioning

Supine position or semi supine

3-5 lead EKG Positioning

Also known as traveling EKG

Any positioning but ensure patient does not remove the leads and continues with activities

Stress Testing Positioning

Patient is on the treadmill so they are active during this EKG

Lead I

DIFFERENT FROM V1

Records impulses between left and right arms

Lead II

DIFFERENT FROM V2

Records impulses between right arm and left leg

Lead III

DIFFERENT FROM V3

Records impulses between the left arm and left leg

Lead AVL

The left leg and right arm assist with the left arm tracing

Lead AVR

The left arm and left leg assist with the right arm tracing

Lead AVF

The right and left arms assist with the left leg tracing

First 3 Leads

Bipolar and record impulses that travel from a negative to positive pole at specific positions in the heart

Last 3 Leads

Unipolar and due to poor illustration of waveforms, they must be augmented and get assistance from two poles to enhance the tracing

V1

Fourth intercostal space (ICS), right of sternum

V2

Fourth ICS, left of sternum, directly across from V1

V3

Midway between V2 and V4

V4

Fifth ICS, midclavicular line

V5

Fifth ICS, midway between V4 and V6, at the anterior axillary line

V6

Fifth ICS, at the midaxillary line

Five-lead EKG

White lead: Right sternal border, first rib

Red lead: Right sternal border, third rib

Black lead: Left side, anterior axillary line, fifth rib

Brown lead: Left sternal border, first rib directly opposite the white lead

Green lead: Right lower thoracic area anywhere on the rib

Three-lead EKG

White lead: Right shoulder just below the clavicle

Black lead: Left shoulder just below the clavicle

Red lead: Below the left pectoral muscle at the apex of the heart

Specific Considerations

• Some cardiac conditions (ST segment, elevation, myocardial infarction, dextrocardia) and patient younger than 8 years of require right sides 12-lead EKG

• Posterior placement is rare for inferior wall infarcation

Patient Monitoring

• During the EKG, ALWAYS monitor the patient

• Notify the provider if there are any arrhythmias or other hypotensions

• If cardiac arrest occurs, shut off the machine and alert EMS