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MAKING ECG’S EASYMAKING ECG’S EASY

APPLICATION FOR THEAPPLICATION FOR THEECGECGEVALUATING THE ECGEVALUATING THE ECG

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Upon completion oneUpon completion one

will be able to:will be able to:• Describe wh ! " ECG is#Describe wh ! " ECG is#• Describe !he $r%$er h%%&'($Describe !he $r%$er h%%&'($

$r%ce)(re *%r +,'Le ) ECG$r%ce)(re *%r +,'Le ) ECG• I)e"!i*- b sic "%r. / ECGI)e"!i*- b sic "%r. / ECG

w 0e*%r. .%r$h%/%1-#w 0e*%r. .%r$h%/%1-#• Dis!i"1(ish be!wee" b sic ECGDis!i"1(ish be!wee" b sic ECG

rrh-!h.i ") r!i* c!#rrh-!h.i ") r!i* c!#

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2UICK REVIE3 OF2UICK REVIE3 OFHEARTHEART

P(r$%seP(r$%se• P(.$s b/%%)P(.$s b/%%) 4 sic A" !%.-4 sic A" !%.-•

5 ch .bers5 ch .bers• , si)es, si)es• 5 0 /0es5 0 /0es

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THE CONDUCTINGYHE CONDUCTINGY

SYSTEYSTE

• SA N%)eSA N%)e• I"!er'"%) /I"!er'"%) /

$ !hw -$ !hw -• AV N%)eAV N%)e• 4(")/e %* HIS4(")/e %* HIS

• 4(")/e 4r "ches4(")/e 4r "ches• P(r&i"6e FibersP(r&i"6e Fibers

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RELATIONSHIPRELATIONSHIP

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CARDIAC CYCLESCARDIAC CYCLES

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+, LEAD ECG+, LEAD ECG

Le r"i"1 %b6ec!i0es7Le r"i"1 %b6ec!i0es7

Describe !he c%rrec!Describe !he c%rrec!$/ ce.e"! %* // e/ec!r%)es$/ ce.e"! %* // e/ec!r%)es

Pr%$er S&i" $re$ r !i%"Pr%$er S&i" $re$ r !i%" C re %* !he ECG . chi"e8 wiresC re %* !he ECG . chi"e8 wires

") e/ec!r%)es") e/ec!r%)es

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Pri"ci$/es %*Pri"ci$/es %*E/ec!r%c r)i%1r $hE/ec!r%c r)i%1r $h

• E/ec!r%c r)i%1r $h 9 is !heE/ec!r%c r)i%1r $h 9 is !hei"s!r(.e"! !h ! rec%r)s !hei"s!r(.e"! !h ! rec%r)s !hee/ec!ric / c!i0i!- %* !he he r!e/ec!ric / c!i0i!- %* !he he r!

• E/ec!r%c r)i%1r . :ECG; is !heE/ec!r%c r)i%1r . :ECG; is !herec%r) %* !h ! c!i0i!-rec%r) %* !h ! c!i0i!-

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HOOKING UP THEHOOKING UP THE+,'LEAD ECG+,'LEAD ECG

• Pr%$er s&i" $re$Pr%$er s&i" $re$• P/ ce.e"! %* !he /i.bP/ ce.e"! %* !he /i.b

e/ec!r%)ese/ec!r%)es•

P/ ce.e"! %* !he ches!P/ ce.e"! %* !he ches!e/ec!r%)ese/ec!r%)es

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SKIN PREPARATIONKIN PREPARATION

• REASON FOR SKINREASON FOR SKINPREPARATIONPREPARATION

• < STEP METHOD< STEP METHOD• , STEP METHOD, STEP METHOD

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ELECTRODEELECTRODEPLACEMENTPLACEMENT

• LIM4 LEADSLIM4 LEADS

• CHEST LEADCHEST LEAD

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LIM4 LEADSLIM4 LEADS

• 4i$%/ r /e )s4i$%/ r /e )s

I II IIII II III

• A(1.e"! /e )sA(1.e"! /e )s

A0r A0/ A0* A0r A0/ A0*

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CHEST LEADSCHEST LEADS

• = UNIPOLAR= UNIPOLARLEADSLEADS

• V+V+• V,V,• V>V>

• V5V5• V<V<• V=V=

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LETS REVIE3LETS REVIE3

• 3h ! is " ECG3h ! is " ECG• 3h ! re !he /i.b /e )s?3h ! re !he /i.b /e )s?• 3h ! re !he ches! /e )s?3h ! re !he ches! /e )s?

• 3h- )% s&i" $re$?3h- )% s&i" $re$?

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+,'LEAD ECG LAYOUT+,'LEAD ECG LAYOUT

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INFORMATION ON THEINFORMATION ON THEECGECG

• P !ie"!s )e.%1r $hicsP !ie"!s )e.%1r $hics• He r! r !e ") .e s(re.e"!sHe r! r !e ") .e s(re.e"!s• S$ee) ECG is rec%r)e) !S$ee) ECG is rec%r)e) !

• V%/! 1e ECG is rec%r)e) !V%/! 1e ECG is rec%r)e) !• 3h ! !he *i/!er is se! %"3h ! !he *i/!er is se! %"

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INFORMATION ON THEINFORMATION ON THE+,'LEAD ECG+,'LEAD ECG

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3HAT YOU NEED TO3HAT YOU NEED TOLOOK FORLOOK FOR

• Are !he /i.b /e )s h%%&e) ($Are !he /i.b /e )s h%%&e) ($c%rrec!/-?c%rrec!/-?

• Are !he ches! /e )s h%%&e) ($Are !he ches! /e )s h%%&e) ($c%rrec!/-?c%rrec!/-?

• Is !he ECG *ree %* r!i* c!#Is !he ECG *ree %* r!i* c!#• Is !his ECG Cri!ic / V /(eIs !his ECG Cri!ic / V /(e

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IS !he ECG HOOKED UPIS !he ECG HOOKED UPCORRECTLY?CORRECTLY?

LIM4 LEADSLIM4 LEADSN%r. / +,'/e )N%r. / +,'/e )

• AVR 9 /w -sAVR 9 /w -s"e1 !i0e"e1 !i0e

• Le ) I 9 /w -sLe ) I 9 /w -s$%si!i0e$%si!i0e

• Le ) II8 III 9Le ) II8 III 9$%si!i0e %r$%si!i0e %rbi$h sicbi$h sic

CHEST LEADSCHEST LEADSCOLUMN IIICOLUMN III•

R w 0e $r%1ressi%"R w 0e $r%1ressi%"• S. // !% T //S. // !% T //

COLUMN IVCOLUMN IV• R w 0e $r%1ressi%"R w 0e $r%1ressi%"• T // !% S. //T // !% S. //

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RULING OUT LIM4 LEADRULING OUT LIM4 LEADREVERSALREVERSAL

• A0r is /w -s "e1 !i0eA0r is /w -s "e1 !i0e

• Le ) I is /w -s $%si!i0eLe ) I is /w -s $%si!i0e

• Le ) II ") III $%si!i0e *%r !he PLe ) II ") III $%si!i0e *%r !he Pw 0e ") (s( //- !he 2RS c%.$/e@w 0e ") (s( //- !he 2RS c%.$/e@

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LIM4 LEADSLIM4 LEADS

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CHEST LEADSCHEST LEADS

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OTHER PRO4LEMSOTHER PRO4LEMS3ITH THE ECG3ITH THE ECG

• Ar!i* c!Ar!i* c!• E/ec!ric / i"!er*ere"ceE/ec!ric / i"!er*ere"ce• S%. !ic !re.%r S%. !ic !re.%r

• 3 ")eri"1 b se/i"e3 ")eri"1 b se/i"e

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EINTHOVENS TRIANGLEEINTHOVENS TRIANGLE

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ARTIFACT ON THE ECGARTIFACT ON THE ECG

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FIND THE ARTEFACTFIND THE ARTEFACT

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3ANDERIN 4ASELINE3ANDERIN 4ASELINE

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SOMATIC TREMORSOMATIC TREMOR

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ELECTRICALELECTRICALINTERFERANCEINTERFERANCE

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4ASIC CRITICAL4ASIC CRITICALVALUESVALUES

• 4r )-c r)i 9 HR4r )-c r)i 9 HR 5Bb$.5Bb$.• T ch-c r)i HRT ch-c r)i HR +,Bb$.+,Bb$.• PVC’s ' 5 %r .%re i" r%wPVC’s ' 5 %r .%re i" r%w•

ST E/e0 !i%"ST E/e0 !i%"

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LOOKING AT THELOOKING AT THERHYTHMRHYTHM

• E0 /( !e !heE0 /( !e !herh-!h. s!ri$ !rh-!h. s!ri$ !

!he b%!!%. %*!he b%!!%. %*!he +,'/e ) *%r!he +,'/e ) *%r!he *%//%wi"1!he *%//%wi"1

• Is !he rh-!h.Is !he rh-!h.re1(/ r %rre1(/ r %r

irre1(/ r?irre1(/ r?• Is !here PIs !here Pw 0e be*%rew 0e be*%ree0er- 2RSe0er- 2RS

c%.$/e@c%.$/e@• Are !he- "-Are !he- "-

b"%r. / be !s#b"%r. / be !s#

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FINDING THE HEARTFINDING THE HEARTRATERATE

• > METHODS> METHODS

• RATE RULERRATE RULER• COUNTINGCOUNTING

• 4O METHOD4O METHOD

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4O METHOD4O METHOD

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ECTOPIC 4EATSECTOPIC 4EATS

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LETS SUMMARI ELETS SUMMARI E

H%w )% we $r%)(ce " e@ce//e"!H%w )% we $r%)(ce " e@ce//e"!+,'/e ) ECG?+,'/e ) ECG?

Pr%$er s&i" $re$Pr%$er s&i" $re$ C%rrec! e/ec!r%)e $/ ce.e"!C%rrec! e/ec!r%)e $/ ce.e"! Rec%1"i e ") &"%w h%w !%Rec%1"i e ") &"%w h%w !%

c%rrec! $r%b/e.sc%rrec! $r%b/e.sRec%1"i e b sic cri!ic / 0 /(esRec%1"i e b sic cri!ic / 0 /(es