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The 12 Lead ECG in Acute Coronary Syndromes

The 12 Lead ECG in Acute Coronary Syndromes. Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services. Sponsored by:. 12-Lead ECG in ACS Course. Module I Essential Interpretation Module II Acquisition & Transmission Module III Acute Coronary Syndromes Part 1

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The 12 Lead ECG in Acute Coronary Syndromes

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  1. The12 Lead ECGin Acute Coronary Syndromes Eric Lynn NREMT-P Clinical Education Specialist Amarillo Medical Services

  2. Sponsored by:

  3. 12-Lead ECG in ACS Course • Module I Essential Interpretation • Module II Acquisition & Transmission • Module III Acute Coronary Syndromes Part 1 • Module IV Acute Coronary Syndromes Part 2 • Module V The High Acuity Patient • Module VI Bundle Branch Block & the ACS Imitators

  4. MODULE 1 Essential 12-Lead Interpretation

  5. Essential 12-Lead ECG Interpretation • Goals • Recognize and localize AMI on the 12-Lead ECG • Feel comfortable with 12-lead interpretation

  6. 12-Lead ECG

  7. 12-Lead ECG

  8. 12-Lead ECG

  9. 12-Lead ECG

  10. 12-Lead ECG

  11. 12-lead ECG

  12. 12-Lead ECG 080.0 0.080 80 milliseconds = 0.08 seconds

  13. 12-Lead ECG

  14. R Wave

  15. Q Wave

  16. S Wave

  17. QRS • Q waves • Physiologic Q waves • < .04 sec (40ms) • Pathologic Q • >.04 sec (40 ms)

  18. QRS • Q wave

  19. QS Complex

  20. J-Point

  21. ST Segment

  22. Practice • Find J-points and ST segments

  23. Practice • Find J-points and ST segments

  24. ST Segment • Compare to TP segment ST TP

  25. ST Segment Analysis

  26. 12-Lead ECG • AMI recognition • Two things to know • What to look for • Where you are looking

  27. AMI Recognition • What to look for • ST segment elevation • One millimeter or more (one small box) • Present in two anatomically contiguous leads

  28. ST Segment Elevation • Presumptive evidence of AMI • Indication for acute reperfusion therapy

  29. Practice

  30. Lead “Views”

  31. Lead Groups I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Limb Leads Chest Leads

  32. Lead “Views”

  33. Anatomical Position

  34. Inferior Wall • II, III, aVF • Left Leg I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  35. Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Inferior Wall

  36. Lateral Wall • I and aVL • Left Arm I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  37. Lateral Wall • V5 and V6 • Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  38. Lateral • I, aVL, V5, V6 Lateral Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  39. Anterior Wall • V3, V4 • Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  40. Anterior Wall • V3, V4 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  41. Septal Wall • V1, V2 • Along sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  42. Septal • V1,V2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

  43. I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 AMI Localization Anterior: V3, V4 Septal: V1, V2 Inferior: II, III, AVF Lateral: I, AVL, V5, V6

  44. AMI Recognition I Lateral aVR V1 Septal V4 Anterior II Inferior aVL Lateral V2 Septal V5 Lateral III Inferior aVF Inferior V3 Anterior V6 Lateral

  45. AMI Recognition • Know what to look for • ST elevation • > 1mm • Two contiguous leads • Know where you are looking • Use pocket card as a reference • You will soon have this memorized

  46. Practice

  47. Practice

  48. Evolution of AMI • Hyperacute

  49. Evolution of AMI • Acute

  50. Evolution of AMI • Acute

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