1. EKG Plain Simple Plain and Simple CHAPTER Third Edition Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Lead Morphology and Placement 3

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Media Directory Slide 20 12-Lead Electrode Placement Animation Slide 24 Electrode Placement for Cardiac Monitoring Video Slide 25 Electrode Placement for EKG Video Slide 28 Rule of Electrical Flow Animation

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. EllisElectrocardiography The recording of the heart’s electrical impulses by way of electrodes on the skin Willem Einthoven: “Father of electrocardiography” and the inventor of the EKG machine

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Bipolar Leads Three leads, all with positive and negative poles –Lead I: Right arm to left arm. Left arm is positive electrode –Lead II: Right arm to left leg. Left leg is positive electrode –Lead III: Left arm to left leg. Left leg is positive electrode

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-1 The Bipolar Leads

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Triaxial Diagram Formed by joining the lines representing Leads I, II, and III at the middle

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-2 The Triaxial Diagram

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Einthoven’s Triangle Formed by joining the lines representing leads I, II, and III at their ends

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-3 Einthoven’s Triangle

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Einthoven’s Law Lead I + Lead III = Lead II Lead II should have the tallest QRS complex of the bipolar leads Can help determine if leads were inadvertently placed on wrong limb

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-4 Einthoven’s Law

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Augmented Leads Three leads, all with only a positive pole (unipolar leads) –AVR: On right arm –AVL: On left arm –AVF: On left foot EKG machine augments the waveforms’ size

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-5 The Augmented Leads

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-6 Triaxial Diagram with Augmented Leads

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Hexiaxial Diagram Formed by joining the lines representing leads I, II, III, AVR, AVL, and AVF at the middle

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-7 Hexiaxial Diagram

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Bipolar and Augmented Leads are also Called Frontal leads, as they are all located on the front of the body Standard leads Limb leads

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Precordial (Chest) Leads Six unipolar leads that see the heart from the horizontal plane. All are positive electrodes V1 V2 V3 V4 V5 V6

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-8 The Precordial Leads

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis 12-Lead Electrode Placement Animation Click on the screenshot to view an animation showing 12-Lead Electrode Placement. Click again to pause the animation. Back to Directory

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Continuous Monitoring Allows monitoring of rhythm for a prolonged time Requires altered electrode placement to minimize artifact Bedside monitoring: Patient attached to an EKG machine by a cable Telemetry: Remote cardiac monitoring of ambulatory patients

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-9 Bedside Monitor

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-10 Lead Placement for Continuous Monitoring

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrode Placement for Cardiac Monitoring Video Click on the screenshot to view a video showing electrode placement for cardiac monitoring. Click again to pause the video. Back to Directory

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrode Placement for EKG Video Click on the screenshot to view a video showing electrode placement for EKG. Click again to pause the video. Back to Directory

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Electrocardiographic Truths Positive QRS written by impulse travelling toward positive electrode Negative QRS from impulse travelling away from positive electrode Isoelectric QRS from impulse travelling perpendicular to positive electrode Flat line written when there is no impulse at all

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-11 Electrocardiographic Truths

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Rule of Electrical Flow Animation Click on the screenshot to view an animation showing the Rule of Electrical Flow. Click again to pause the animation. Back to Directory

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal Vector Vector: Arrow depicting the direction of current flow Normal vector of heart’s current is top to bottom, right to left

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-12 Normal Vector

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections Lead I: QRS should be positive

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-13 Normal QRS Deflection in Lead I

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections Lead II: QRS should be positive

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-14 Normal QRS Deflection in Lead II

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections Lead III: QRS should be positive

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-15 Normal QRS Deflection in Lead III

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections AVR: QRS should be negative AVR is the only frontal lead with a negative QRS

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-16 Normal QRS Deflection in aVR

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections AVL: QRS should be positive

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-17 Normal QRS Deflection in aVL

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections AVF: QRS should be positive

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-18 Normal QRS Deflection in aVF

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections V 1 : QRS should be negative

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-19 Normal QRS Deflection in V 1

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections V 6 : QRS should be positive

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Figure 3-20 Normal QRS Deflection in V 6

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections The precordial leads will show a transition from negative (V 1 to V 2 ) to isoelectric (V 3 to V 4 ) to positive (V 5 to V 6 )

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Normal QRS Deflections

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Classroom Response System

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 1 On your EKG, Lead I is 5 mms tall, Lead II is 12 mms tall, and Lead III is 9 mms tall. Based on Einthoven’s Law, you conclude that A.The leads were properly placed B.The leads may have been inadvertently placed on the wrong limbs

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 1 (continued) On your EKG, Lead I is 5 mms tall, Lead II is 12 mms tall, and Lead III is 9 mms tall. Based on Einthoven’s Law, you conclude that C.Einthoven’s Law has nothing to do with lead placement D.Lead II should have a smaller QRS complex

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 1 Answer On your EKG, Lead I is 5 mms tall, Lead II is 12 mms tall, and Lead III is 9 mms tall. Based on Einthoven’s Law, you conclude that A.The leads were properly placed B.The leads may have been inadvertently placed on the wrong limbs

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 1 Answer (continued) On your EKG, Lead I is 5 mms tall, Lead II is 12 mms tall, and Lead III is 9 mms tall. Based on Einthoven’s Law, you conclude that C.Einthoven’s Law has nothing to do with lead placement D.Lead II should have a smaller QRS complex

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 2 Leads I and AVR share which limb in common? A.Right arm B.Right leg C.Left arm D.Left leg

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 2 Answer Leads I and AVR share which limb in common? A.Right arm B.Right leg C.Left arm D.Left leg

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 3 Which of the following leads have a positive pole on the left arm? A.II, III, AVF, and V5 B.I and AVL C.I, AVR, and V1 D.V1 and V2

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 3 Answer Which of the following leads have a positive pole on the left arm? A.II, III, AVF, and V5 B.I and AVL C.I, AVR, and V1 D.V1 and V2

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 4 Your patient has a positive QRS in AVR. This means the current of her heart is travelling A.Toward the right arm B.Away from the right arm C.Toward the left arm D.Away from the left arm

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 4 Answer Your patient has a positive QRS in AVR. This means the current of her heart is travelling A.Toward the right arm B.Away from the right arm C.Toward the left arm D.Away from the left arm

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 5 The QRS complex should be negative in which leads? A.II, III, AVF B.I, AVL, V5-6 C.AVR, V5, V6 D.AVR, V1, V2

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. EKG Plain and Simple, Third Edition Karen M. Ellis Pop Question 5 Answer The QRS complex should be negative in which leads? A.II, III, AVF B.I, AVL, V5-6 C.AVR, V5, V6 D.AVR, V1, V2