1. chapter Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The 15-Lead ECG 10 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

2. Chapter 10 Objectives Describe the benefits of acquiring a 15-lead ECG Describe the proper lead placement for Leads V4R, V8, and V9 Describe the hemodynamic problems associated with a right ventricular infarction List 3 clinical signs of RVI On a 15-lead ECG, recognize ECG changes for a posterior and right ventricular MI 109

3. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Why a 15-Lead ECG? 12-lead alone misses 50% of the AMIs 15-lead ECG increases sensitivity by 23% 23 more out of 100 could be diagnosed 109

4. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Acquiring the 15-Lead (V4R) Run standard 12-lead Lead V4R: 5th IC space midclavicular on right side Same as left side V4 Attach V4 wire to the V4R position 110

5. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Acquiring a 15-Lead (V8, V9) Posterior leads V8: 5th IC space midscapular line V9 goes between V8 and the spine Place Lead V5 wire on V8 and V6 wire on V9 Acquire the second 12- lead Re-label the new leads

6. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Right Ventricular Infarction RV gets blood supply from the RCA Up to 50% of inferior MI will have RVI Preload problems Use nitrates with extreme caution Fluid bolus of perhaps 1 liter or more is indicated

7. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Clinical Signs of RVI Jugular vein distention (JVD) Hypotension, either presenting or following nitro administration Clear lung sounds

8. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 15-Lead ECG 111

9. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Practice Cases Using the 15-Lead

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