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Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation-

Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation-. Ontario Base Hospital Group Education Subcommittee 2008. TIME IS MUSCLE. Introduction to 12 Lead Interpretation. REVIEWERS/CONTRIBUTORS Neil Freckleton, AEMCA, ACP Hamilton Base Hospital Jim Scott, AEMCA, PCP

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Chapter 6 for 12 Lead Training -Introduction to 12 Lead Interpretation-

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  1. Chapter 6 for 12 Lead Training-Introduction to 12 Lead Interpretation- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE

  2. Introduction to 12 Lead Interpretation REVIEWERS/CONTRIBUTORS Neil Freckleton, AEMCA, ACP Hamilton Base Hospital Jim Scott, AEMCA, PCP Sault Area Hospital Ed Ouston, AEMCA, ACP Ottawa Base Hospital Laura McCleary, AEMCA, ACP SOCPC Tim Dodd, AEMCA, ACP Hamilton Base Hospital Dr. Rick Verbeek, Medical Director SOCPC AUTHOR Greg Soto, BEd, BA, ACP Niagara Base Hospital 2008 Ontario Base Hospital Group

  3. Chapter 6 - Objectives • Recognize the usefulness of ECG data provided by computerized 12 Lead ECG • Identify important features of ECG such as Q, R, S, T waves and relate to 12 Lead interpretation • Find J-points and compare to TP segments • Recognize ST-elevation and relate to clinical significance • Become comfortable with recognizing and locating AMI on 12 Lead ECG • Practice a bit of 12 Lead interpretation

  4. 12 Lead Interpretation • Interpretation vs. STEMI Recognition • It is important to note that upon completion of this training, it is not expected that paramedics will be “interpreting” a 12 Lead but rather recognizing STEMI patients

  5. Learning 12 Lead ECG Interpretation Common Paramedic responses prior to learning 12 Lead ECG Interpretation: • I can’t interpret a 12 Lead ECG like a Cardiologist! • Are you kidding me? Common Paramedic responses after learning 12 Lead ECG Interpretation: • Hey – that wasn’t as hard as I thought it would be!

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

  7. 12 Lead ECG

  8. 12 Lead ECG

  9. 12 Lead ECG

  10. R Wave

  11. Q Wave

  12. S Wave

  13. J-Point

  14. ST Segment

  15. The J Point • J point - end of QRS complex & beginning of ST segment

  16. Practice • Find J-points and ST segments

  17. Practice • Find J-points and ST segments

  18. 12-Lead ECG • AMI recognition • Two things to know • What to look for • Where to look Local medical oversight will determine the criteria used to identify a STEMI patient. All stakeholders must be consulted to determine what criteria should be utilized in a given centre.

  19. What to look for • Example - ST segment elevation • One millimetre or more (one small box) in limb leads • Two millimetres or more (two small boxes) in chest leads • Present in two anatomically contiguous leads

  20. Contiguous Leads • Limb leads that “look” at the same area of the heart OR • Numerically consecutive chest leads

  21. Contiguous Leads • Inferior wall: II, III, avF • Lateral wall: I, aVL, V5, V6 • Septum: V1 and V2 • Anterior wall: V3 and V4 • Posterior wall: V7, V8, V9 (leads placed on the patient’s back 5th intercostal space creating a 15 lead EKG)

  22. Where to look • ST segment elevation measurement • 0.04 seconds after J point

  23. ST Segment Elevation

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

  25. ST Segment • Compare to TP segment ST TP

  26. ST Segment Analysis

  27. Practice

  28. Lead “Views”

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

  30. Lead “Views”

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

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

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

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

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

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

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

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

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

  40. 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

  41. 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

  42. Know what to look for ST elevation > 1mm in limb leads > 2mm chest leads Two contiguous leads Know where you are looking You will soon have this memorized AMI Recognition

  43. Rhyme, phrase or device for remembering something “LII – LI – ASS (backwards) – ALL” L = I (Lateral) I = II (Inferior) I = III (Inferior) L = aVL (Lateral) I = aVF (Inferior) Mnemonic for Location S = V1 (Septal) S = V2 (Septal) A = V3 (Anterior) A = V4 (Anterior) L = V5 (Lateral) L = V6 (Lateral)

  44. Using mnemonic on ECG • You may want to write the Letters in the corner of each Lead when interpreting S A L I S L L I I A L

  45. Antero Septal

  46. Extensive Anterior

  47. Inferior

  48. Extensive Anterior

  49. Inferior

  50. Extensive Anterior

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