EKGs: How do I know if it s good enough? Phlebotomy 2016

Transcription

1 EKGs: How do I know if it s good enough? Phlebotomy 2016

2 Objectives Understand basic functioning of the heart Understand the purpose of 12-lead EKGs Demonstrate correct lead placement for obtaining quality 12-lead EKGs Recognize baseline wander and artifact in an EKG

3 The Heart The heart is a big ball of muscle This muscle pumps deoxygenated (used) blood returning from the body into the lungs to get re-oxygenated It then pumps the oxygenated blood to the body

4 The Heart Because the heart is made of muscle electrical signals are needed to make it beat These electrical signals are represented as lines on an EKG Each part of the line represents something different

5 12-lead EKGs: What are they for? You may see patients on a telemetry monitor, this is like a condensed version of a 12-lead A 12-lead EKG shows us a 3-D picture of the electrical activity in the heart Allows for specific diagnosis

6 12-lead EKGs Lets look at a typical 12-lead print out It may look like a bunch of squiggly lines all running together But in fact, it is the 12 different pictures of the heart s conduction Includes some large pictures of major leads at the bottom

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8 Lead Placement Where you place the leads during an EKG is very important If it is off as much as a centimeter it can cause major deviation Sometimes incorrect lead placement can mimic serious heart disease

9 Lead Placement

10 What s wrong with these placements? V3 is incorrectly placed

11 What s wrong with these placements? V4, V5 and V6 should be in a straight line

12 What s wrong with these placements? V1 and V2 are too far apart V3 should be at a diagonal between V2 and V4

13 A few pointers about placement If your patient is hairy, shave them! If your patient is wet, dry them! Do not apply leads over breast tissue Limb leads can go on limbs or torso Do not place leads over pacemakers or central line ports

14 How to know when an EKG is good enough to capture: I ve got the green light/all three dots are full, that means it s good right? WRONG! Sometimes the machine thinks it is a quality EKG when in fact it s not Need to use your own judgment skills

15 Does this mean I m reading the EKG?! NO! You are not responsible for reading or interpreting the EKG There are two major things to look for before you capture an EKG, and they have nothing to do with interpreting or reading the EKG itself Baseline Artifact

16 Major Points Baseline What is baseline? Baseline means that all the EKG leads follow a straight line after the up and down deflections there is still a nice even line across the page Ignore everything but the big picture

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20 Major Points Baseline Can be affected by Poor lead placement Heavy breathing Agitated or uncomfortable patient

21 Major Points-Artifact What is artifact? We ve already discussed that EKGs read electrical signals that you heart gives off as it beats But it s not just the heart that gives off these signals all other muscles in your body do When someone is not lying still during an EKG all the extra muscle movement shows up as noise on the EKG, also known as artifact

22 Quality EKG No Artifact

23 Poor EKG Lots of Artifact

24 How can I tell the difference between artifact and the EKG? Sometimes it can be hard to tell If you are ever not sure, ask! Tips: Look at the rest of the EKG does it all look fairly similar? Are there a bunch of up and down lines all bunched together? That s artifact. Make sure your patient is holding as still as possible Ensure no one else is touching the patient or the bed Keep lead wires neat and uncrossed Lay your patient as flat as possible

25 Preventing Artifact and Baseline Wander Try and lay the patient as flat as possible Patient condition permitting Explain to the patient that they should remain as still as possible, and that the test doesn t take long Ensure all extremities are relaxed Sometimes patients with muscle tremors have artifact and it can t be helped

26 PRACTICE!

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31 Disclaimer*** It is understood that the patient s condition may not permit for a high quality EKG right away i.e. in severe pain, seizures, respiratory distress etc. Do the best you can However, if a quality EKG cannot be obtained initially, it should be repeated once the patient is stabilized

32 Review You are not responsible for reading or interpreting the EKG in any way Your responsibility is to get a high quality EKG tracing ensuring correct lead placement and clear capture

33 Reference Dubin, D. (2000). Rapid Interpretation of EKG's (6th ed.). Ft. Myers, FL: Cover Publishing Company.