1. chapter Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 2 Understanding the 12-Lead ECG Printout

2. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 2 Objectives Locate bipolor, unipolar, and precordial leads on a printout Find measurement information Discuss the benefits and limitations of the machine analysis Demonstrate how to validate a 12-lead Convert measurements from seconds to milliseconds Locate the isoelectric line using the calibration spike as a reference 11

3. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Standard Hospital Printout 12

4. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Data Columns 13

5. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Simultaneous Recording 14

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

7. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Converting Measurements From seconds to milliseconds Move the decimal point three places to the right 0.108 seconds is 108 milliseconds 17

8. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Machine Analysis Machines analyze data for a conclusion People interpret the electrocardiogram May give erroneous readings Acute care providers must be able to tell the difference

9. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Isoelectric Line Basis for all voltage measurements ST segment elevation/depression Hypertrophy Usually found at the bottom of calibration bar 18

10. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 12-Lead Validation Limb leads P wave, QRS, and T wave upside down in Lead I Global negativity Upper limb leads switched 18

11. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 12-Lead Validation R wave progression R waves progress in size from V1 to V4 If poor progression, check lead placement on electrodes normal poor

12. Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 2 Fun! Run 12-leads with the leads in the right and wrong places and see if you can spot the invalidity Collect various 12-lead ECGs from this point on and study which ones the machine’s analysis gets right and wrong