ECG UPDATE COURSE DESCRIPTION

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1 ECG UPDATE COURSE DESCRIPTION This CE course discusses techniques to improve ECG quality, interpretation of normal and abnormal ECG tracings, and troubleshooting ECG tracings. Note: An internet connection is required to complete this course. Rev 2.0 March

2 COURSE TITLE: ECG UPDATE Author: Lucia Johnson, M.A. Ed, MT(ASCP)SBB Vice President, Recertification National Center for Competency Testing Number of Clock Hours Credit: 4.0 Course # P.A.C.E. Approved: _ Yes X_ No OBJECTIVES Upon completion of this continuing education course, the professional should be able to: 1. Identify methods and techniques used to improve ECG quality. 2. Review the basics of electrocardiography. 3. Describe and recognize normal and abnormal ECG tracings. 4. Identify causes of abnormal ECG tracings. 5. Describe factors affecting ECG trace quality. 6. Troubleshoot common ECG tracing artifacts. Disclaimer The writers for NCCT continuing education courses attempt to provide factual information based on literature review and current professional practice. However, NCCT does not guarantee that the information contained in the continuing education courses is free from all errors and omissions. 2

3 INTRODUCTION Ensuring quality ECG data is of utmost importance in providing accurate and timely diagnosis and treatment of patients. This CE course provides links to internet articles that discuss techniques to improve ECG quality, identify normal and abnormal ECG tracings, identify factors that affect ECG quality, and troubleshoot common ECG artifacts. Why are we sending you to the internet to read course material? The articles selected for this course are copyrighted. Therefore, we cannot provide them in printed or electronic form for you to use. We can however send you to the websites to read/print a copy for your individual use. The educators at NCCT also consider the ability to use the internet to learn and/or review information as important for continuing education purposes. ARTICLE 1: IMPROVING ECG QUALITY Cut and paste the following link into your internet browser /577817/577869/Improving_ECG_Quality_Application_Note_%28ENG%29. pdf%3fnodeid%3d %26vernum%3d3 Print and read the article entitled Improving ECG Quality. CE test questions 1-5 are over information in this article. ARTICLE 2: CONQUERING THE ECG Cut and paste the following link into your internet browser. Print and/or read the article entitled Chapter 3: Conquering the ECG. Note: There are 21 figures and four tables included in this article. If you print the article to read, there will be 33 pages total. If you are reading this article online, when you see a notation such as (see Figure X) or (see Table X), with X being a number, click on the notation and you will be taken directly to the figure or table. CE test questions 6-16 are over information in this article. ARTICLE 3: FACTORS AFFECTING ECG TRACE QUALITY Cut and paste the following link into your internet browser. VuQEcuZgVs6EVs6E Print and/or read the article entitled Factors Affecting ECG Trace Quality. 3

4 CE test questions are over information in this article. CONCLUSION The information provided in the reading materials for this course discussed techniques to improve the quality of ECG data, provided a review of basic electrocardiography, identified normal and abnormal ECG tracings, and provides assistance in troubleshooting common ECG artifacts. While this information is most likely not new to healthcare professionals who routinely perform ECG testing, a periodic review is recommended to assure quality ECG test results are continuously produced. QUESTIONS ECG Update # Directions: Before taking this test, read the instructions on how to complete the answer sheets correctly. If taking the test online, log in to your User Account on the NCCT website Select the response that best completes each sentence or answers each question from the information presented in the module. If you are having difficulty answering a question, go to and select Forms/Documents. Then select CE Updates and Revisions to see if course content and/or a test questions have been revised. If you do not have access to the internet, call Customer Service at Questions 1 5: Improving ECG Quality 1. What is the purpose of cleaning and drying of the skin prior to applying the ECG electrodes? a. Ensures sterility is maintained b. Increases ECG signal amplitude c. Improves electrode adhesion d. Minimizes skin irritation 2. Alcohol is not recommended for skin preparation because? a. It interferes with skin to electrode contact b. It may diminish electrical flow c. It may increase electrical flow d. It removes too much of the epidermis 3. Using an ECG skin prep pad with a fine abrasive sandpaper finish helps to. a. diminish electrical flow b. increase average impedance c. increase capillary blood flow d. reduce motion artifact 4

5 4. Which of the following is FALSE regarding the use of quality electrodes? a. Discard electrodes after Use by date. b. Mix different brands of electrodes. c. Periodically change the electrodes on patients with long-term monitoring. d. Tightly seal packages containing large numbers of electrodes. 5. Which of the following should be avoided during electrode application? a. Applying electrodes to major muscles b. Attaching the electrodes to flat fleshy areas c. Attaching the lead wire to the electrode before applying d. Pressing around the entire edge of the electrode after application Questions 6 16: Conquering the ECG 6. Limb leads show the heart in a plane. a. caudal b. horizontal c. lateral d. vertical 7. Which of the following is called the heart s pacemaker? a. atrioventricular node b. bundle of His c. Purkinje fibers d. sinoatrial node 8. The P wave represents. a. atrial depolarization b. atrial polarization c. ventricular depolarization d. ventricular polarization 9. Which of the following is seen on the ECG when a patient has atrial fibrillation? a. Absent P waves b. Prolonged QRS complexes c. Sawtooth waveform d. Small Q waves 10. Which of the following is a normal ECG variation? a. Large QRS complex b. Long QT interval c. Long PR interval d. ST elevation following an S wave 5

11. A distance of more than five small squares from the start of a P wave to the start of the R wave identifies a. a. atrial flutter b. digoxin toxicity c. first-degree heart block d.

6 11. A distance of more than five small squares from the start of a P wave to the start of the R wave identifies a. a. atrial flutter b. digoxin toxicity c. first-degree heart block d. sinus tachycardia 12. A wide QRS complex despite sinus rhythm is seen in. a. bundle branch block b. pericarditis c. previous infarction d. pulmonary embolism 13. T-wave inversion can be seen in. a. right bundle branch block b. hyperkalemia c. current ischemia d. right ventricular hypertrophy 14. Which of the following antibiotics can increase the QT interval? a. Erythromycin b. Fluoxetine c. Lithium d. Tamoxifen 15. The ECG below represents. a. atrial flutter b. bundle branch heart block c. first-degree heart block d. pulmonary embolism 6

16. The ECG below represents. a. atrial fibrillation b. digoxin toxicity c. normal sinus rhythm d. previous infarction Questions 17 20: Factors Affecting ECG Trace Quality 17.

7 16. The ECG below represents. a. atrial fibrillation b. digoxin toxicity c. normal sinus rhythm d. previous infarction Questions 17 20: Factors Affecting ECG Trace Quality 17. Which of the following is an environmental factor that affects ECG trace quality? a. Amplifier noise b. Electrode gel c. Skin oiliness d. Static electricity 18. When performing an ECG, the healthcare professional notices the baseline is wandering. What is the first thing that should be done to troubleshoot this issue? a. Check ground connections b. Stop patient movement c. Abrade the skin d. Check for static buildup 19. The healthcare professional notices AC noise on the ECG. After ensuring the ground connections are satisfactory, what is the next step in troubleshooting this problem? a. Abrade the skin b. Check for dry out c. Check for loose electrode d. Keep the cable away from the AC cord 20. When performing an ECG, the healthcare professional notices motion artifact is occurring. What is the first thing that should be done to troubleshoot this issue? a. Perform a continuity check b. Turn off fluorescent lights c. Move the electrodes off of muscle mass d. Check for proper setup of the ECG machine *End of Test* 7

3/26/15 HTEC 91. EKG Sign-in Book. The Cardiac Cycle. Parts of the ECG. Waves. Waves. Review of protocol Review of placement of chest leads (V1, V2)

3/26/15 HTEC 91. EKG Sign-in Book. The Cardiac Cycle. Parts of the ECG. Waves. Waves. Review of protocol Review of placement of chest leads (V1, V2) EKG Sign-in Book HTEC 91 Review of protocol Review of placement of chest leads (V1, V2) Medical Office Diagnostic Tests Week 2 http://www.cvphysiology.com/arrhythmias/a013c.htm The Cardiac Cycle Represents