1. ECG Workshop Dr Jeremy Wright Cardiologist Hearts1st, Greenslopes Private Hospital

2. Topics To Cover  Skin preparation  Electrode Placement  Troubleshooting – Minimise Noise / Artifact  Limb Lead Reversal  ECG Examples

3. Skin Preparation  Important to have good contact between the skin and electrodes  Minimises artifact and electrode movement  Things to use: -Razors / part hair to expose skin -Preparation tape -Alcohol wipes

4. Electrode Placement LA = Left Arm RA = Right Arm LL = Left Leg RL = Right Leg (ground)

5. Electrode Placement V1: 4 th intercostal space, R sternal border V2: 4 th intercostal space, L sternal border V3: between V3 and V4 V4: 5 th intercostal space, Mid Clavicular line V5: horizontally in line with V4, Anterior Auxillary line V6: horizontally in line with V4, Mid Auxillary line

6. Noise / Artifact

7. Bed Artifact

8. Limb Lead Reversal Most common mistake made when acquiring ECG’s. Be sure to check all leads (especially limb leads) before acquiring the ECG.

9. Limb Lead Reversal

10. Alternate Limb Lead Placement How do you perform an ECG in the following situations? -Amputee -Theatre Stockings -Patient with Parkinson's -Disease / Tremors

11. Normal ECG Waveforms

12. A: Ventricular Ectopy

13. A: 2 nd Degree AV Block; Type II

14. A: Complete Heart Block

15. A: Sinus Rhythm with frequent atrial ectopy

16. A: Atrial Fibrillation

17. A: Idioventricular Rhythm

18. A: Acute Anterior MI

19. A: Junctional Rhythm

20. A: Supraventricular Tachycardia

21. A: Ventricular Tachycardia (VT)

22. A: Ventricular Fibrillation (VF)