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Rapid 12 Lead Acquisition

Michael Murley
Michael Murley

This document provides instructions on obtaining a 12-lead electrocardiogram (ECG or EKG). It covers electrode placement, identifying the correct intercostal spaces for chest leads, demonstrating techniques, reducing artifact, and tips. Key points include using gel to improve skin contact and signal strength, cleaning skin first, and troubleshooting to get clear readings, as accurate ECG interpretation requires a high-quality tracing. With practice, paramedics can learn to rapidly obtain 12-lead ECGs even in challenging patients or situations.

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Rapid 12 Lead AcquisitionMichael D. Murley
12 Lead Rapid Acquisition Module 1 Electrode Location
Module 2 Electrode Placement
Module 3 Demonstrations
Module 4 Reducing Artifact
Module 5 Tips and Techniques Module 1 Electrode LocationElectrodes must be placed in the proper position to obtain an accurate 12 Lead ECG
Module 1 Electrode Location12 leads obtained from 10 electrodes 4 on the limbs
6 on the chestModule 1 Electrode LocationLimb lead positioning is simple.The electrodes are placed off the torso, on the limbs. The most correct positioning is near the wrist and ankles. However, EMS generally places the electrodes on/near the torso to limit artifact while transporting.
Module 1 Electrode LocationChest leads have specific anatomic locationsV1, V2, V4 the rest are placed in relationship to these leads
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 1 Electrode Location
Module 2 Electrode PlacementThe key to correctly placing the chest electrodes is finding the 4th intercostal spaceModule 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode PlacementHeres another approach to locating the 4th intercostal space
Module 2 Electrode PlacementBest view laterally
Module 2 Electrode PlacementLocate the supersternal notch (1) at the top of the manubrium
Palpate down appox 2 until you find the sternal angle, slide your finger laterally to the right, youre finger is now on the 2nd rib
Palpate down into the 2nd 3rd and 4th intercostal space1
Module 2 Electrode PlacementAfter placing V2, palpated down to the 5th intercostal space midclavicular line and place V4
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 2 Electrode Placement
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3DemonstrationsIf you were the patient, where would you prefer to have youre 12 Lead done, in the house or in the truck?
Module 3DemonstrationsTheres a lot of people out there and they can see into the ambulance. You should obtain the 12 lead in the house
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 3Demonstrations
Module 4 Reducing ArtifactUnless you have a clear ECG to analyze, all you interruptive skills are of little use
Module 4 Reducing ArtifactStress labs obtain clear ECGs while the Patient is running on a treadmillWe should be able to obtain a 12 lead while the Patient is laying still
Module 4 Reducing ArtifactAs the heart depolarizes, an electrode on the Pts skin picks up the electrical activity
Module 4 Reducing ArtifactIt can also pick up other electrical signals
Module 4 Reducing ArtifactTo reduce artifact, we have to increase the hearts signal and reduce the other electrical activity
Module 4 Reducing ArtifactArtifact Reduction Strategy:Helping the electrode gel to better penetrate the skin will increase the signal strength from the heart and reduce the signal strength from other sources.
Module 4 Reducing Artifact
Module 4 Reducing ArtifactRemove hair with electric clippers
Module 4 Reducing Artifact
Module 4 Reducing ArtifactNow the skin is prepared, we can attach our electrodes
Module 4 Reducing Artifact
Module 4 Reducing Artifact
Module 5Tips and TechniquesSupine is the proper position, if the Pt will tollerate
Module 5Tips and TechniquesWhen the Pt changes position, the heart moves within the chest. This can cause ECG changes similar to a misplaced electrode.
Module 5Tips and TechniquesDo your best to maintain the modesty of a female Pt
Module 5Tips and TechniquesYou could try wide medical tape
Module 5Tips and TechniquesA folded blanket or towel may help hold the electrodes in place
Module 5Tips and TechniquesStrand each lead out individually
When ECG cables are looped around IV lines, O2 tubing, BP cuff tubing, or dangling between squad bench and stretcher you will have more artifact
Make sure the Pt isnt twiddling the ECG cables
If unable to lay supine for ECG, place them semi-fowlers and breathing normally

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Rapid 12 Lead Acquisition

  • 1. Rapid 12 Lead AcquisitionMichael D. Murley
  • 2. 12 Lead Rapid Acquisition Module 1 Electrode Location
  • 3. Module 2 Electrode Placement
  • 4. Module 3 Demonstrations
  • 5. Module 4 Reducing Artifact
  • 6. Module 5 Tips and Techniques Module 1 Electrode LocationElectrodes must be placed in the proper position to obtain an accurate 12 Lead ECG
  • 7. Module 1 Electrode Location12 leads obtained from 10 electrodes 4 on the limbs
  • 8. 6 on the chestModule 1 Electrode LocationLimb lead positioning is simple.The electrodes are placed off the torso, on the limbs. The most correct positioning is near the wrist and ankles. However, EMS generally places the electrodes on/near the torso to limit artifact while transporting.
  • 9. Module 1 Electrode LocationChest leads have specific anatomic locationsV1, V2, V4 the rest are placed in relationship to these leads
  • 10. Module 1 Electrode Location
  • 11. Module 1 Electrode Location
  • 12. Module 1 Electrode Location
  • 13. Module 1 Electrode Location
  • 14. Module 1 Electrode Location
  • 15. Module 1 Electrode Location
  • 16. Module 1 Electrode Location
  • 17. Module 1 Electrode Location
  • 18. Module 1 Electrode Location
  • 19. Module 2 Electrode PlacementThe key to correctly placing the chest electrodes is finding the 4th intercostal spaceModule 2 Electrode Placement
  • 20. Module 2 Electrode Placement
  • 21. Module 2 Electrode PlacementHeres another approach to locating the 4th intercostal space
  • 22. Module 2 Electrode PlacementBest view laterally
  • 23. Module 2 Electrode PlacementLocate the supersternal notch (1) at the top of the manubrium
  • 24. Palpate down appox 2 until you find the sternal angle, slide your finger laterally to the right, youre finger is now on the 2nd rib
  • 25. Palpate down into the 2nd 3rd and 4th intercostal space1
  • 26. Module 2 Electrode PlacementAfter placing V2, palpated down to the 5th intercostal space midclavicular line and place V4
  • 27. Module 2 Electrode Placement
  • 28. Module 2 Electrode Placement
  • 29. Module 2 Electrode Placement
  • 30. Module 2 Electrode Placement
  • 31. Module 2 Electrode Placement
  • 32. Module 2 Electrode Placement
  • 33. Module 2 Electrode Placement
  • 34. Module 2 Electrode Placement
  • 35. Module 2 Electrode Placement
  • 46. Module 3DemonstrationsIf you were the patient, where would you prefer to have youre 12 Lead done, in the house or in the truck?
  • 47. Module 3DemonstrationsTheres a lot of people out there and they can see into the ambulance. You should obtain the 12 lead in the house
  • 57. Module 4 Reducing ArtifactUnless you have a clear ECG to analyze, all you interruptive skills are of little use
  • 58. Module 4 Reducing ArtifactStress labs obtain clear ECGs while the Patient is running on a treadmillWe should be able to obtain a 12 lead while the Patient is laying still
  • 59. Module 4 Reducing ArtifactAs the heart depolarizes, an electrode on the Pts skin picks up the electrical activity
  • 60. Module 4 Reducing ArtifactIt can also pick up other electrical signals
  • 61. Module 4 Reducing ArtifactTo reduce artifact, we have to increase the hearts signal and reduce the other electrical activity
  • 62. Module 4 Reducing ArtifactArtifact Reduction Strategy:Helping the electrode gel to better penetrate the skin will increase the signal strength from the heart and reduce the signal strength from other sources.
  • 63. Module 4 Reducing Artifact
  • 64. Module 4 Reducing ArtifactRemove hair with electric clippers
  • 65. Module 4 Reducing Artifact
  • 66. Module 4 Reducing ArtifactNow the skin is prepared, we can attach our electrodes
  • 67. Module 4 Reducing Artifact
  • 68. Module 4 Reducing Artifact
  • 69. Module 5Tips and TechniquesSupine is the proper position, if the Pt will tollerate
  • 70. Module 5Tips and TechniquesWhen the Pt changes position, the heart moves within the chest. This can cause ECG changes similar to a misplaced electrode.
  • 71. Module 5Tips and TechniquesDo your best to maintain the modesty of a female Pt
  • 72. Module 5Tips and TechniquesYou could try wide medical tape
  • 73. Module 5Tips and TechniquesA folded blanket or towel may help hold the electrodes in place
  • 74. Module 5Tips and TechniquesStrand each lead out individually
  • 75. When ECG cables are looped around IV lines, O2 tubing, BP cuff tubing, or dangling between squad bench and stretcher you will have more artifact
  • 76. Make sure the Pt isnt twiddling the ECG cables
  • 77. If unable to lay supine for ECG, place them semi-fowlers and breathing normally
  • 78. Do not allow Pt to prop themselves up by the arms or you will have muscle tremor artifactModule 5Tips and Techniques If the Pt is cold/shivering, cover with blanket or sheet prior to capturing the 12 LeadModule 5Tips and TechniquesSame Pt as before, covered with a towel
  • 79. Module 5Tips and TechniquesFor some Pts obtaining a clear ECG will be difficult (e.g. respiratory distress Pt, sitting up)However, in most cases it is possible to a 12 Lead ECG with excellent, or at least acceptable data qualityIt just takes effort. A desire to obtain a clean 12 Lead and the knowledge to trouble shoot problems
  • 80. Module 5Tips and TechniquesMyocardial Infarctions are not like broken bones, and therefore, ECGs are not like X-rays.If youre treating a Pt with a broken hip. That x-ray could be taken now, 10 mins from now, an hour from now and what would you see? A broken hip.With MI the events in the coronary artery can be changing moment by moment. The ECG can be very dynamic as well.There is a value to obtaining repeat ECGs when you suspect MI. Making a habit of doing early and repeat ECGs will help you identify a STEMI that could easily be missed.
  • 81. Module 5Tips and Techniques
  • 82. Module 5Tips and Techniques
  • 83. Module 5Tips and TechniquesThis short course provides you with what you need to know in order to rapidly obtain a 12 Lead ECG thats both clear and accurateJust as the case with ECG interpretation, acquisition also requires practice. After youve done this 20 or 30 times, youll become comfortable and confidentFIN