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Technical Aspects of the EKG

4. Technical Aspects of the EKG. The EKG Machine. Electrically speaking, the heart is a transmitter and the EKG machine is the receiver. Figure 4-1 Man Attached to EKG Machine. Control Features. Chart speed: Regulates speed of EKG printout. Normal speed is 25 mm/second

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Technical Aspects of the EKG

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  1. 4 Technical Aspects of the EKG

  2. The EKG Machine • Electrically speaking, the heart is a transmitter and the EKG machine is the receiver

  3. Figure 4-1 Man Attached to EKG Machine

  4. Control Features • Chart speed: Regulates speed of EKG printout. Normal speed is 25 mm/second • Gain: Regulates the amplitude of the EKG waves and complexes. Normal setting is 1 • Document any change in settings

  5. Electrical Safety • Macroshock: High-voltage shock that allows 110 volts to travel through skin • Caused by: Inadequate grounding of electrical equipment (frayed/broken wires or cords, electrical outlet damage, or other) • Results in: Burns, neurologic damage, fatality

  6. Electrical Safety • Microshock: Smaller shock that travels up a conduit into the heart (pacemaker, etc.) • Caused by: Frayed grounding wire or other • Results in: Burns, neurologic damage, fatality

  7. Electrical Safety • ALWAYS CHECK FOR FRAYED WIRES OR COMPONENTS BEFORE DOING AN EKG • NEVER USE A FAULTY MACHINE

  8. Artifact • Unwanted jitter or interference on the EKG tracing • Four kinds • Somatic tremors • Baseline sway • 60-cycle interference • Broken recording

  9. Figure 4-2 Somatic Tremors Artifact

  10. Figure 4-3 Baseline Sway

  11. Figure 4-4 60-Cycle Interference

  12. Figure 4-5 Broken Recording

  13. Troubleshooting • Involves determining and alleviating the cause of artifact and recording errors • Find the common limb of the affected leads and direct corrective efforts there • May involve replacing electrode patches or reattaching loose or detached wires • If artifact is on cardiac monitor in hospital, can change lead selector switch to monitor rhythm in another (clearer) lead

  14. Artifact Troubleshooting Practice 1

  15. Artifact Troubleshooting Practice 2

  16. Artifact Troubleshooting Practice 3

  17. Artifact Masquerading as Asystole • The rhythm looks like asystole (flat-line), but is artifact. Several monitor wires and patches were loose or disconnected. The patient was fine

  18. Figure 4-7 Artifact Masquerading as Asystole (Flat-Line)

  19. True Asystole • The next slide is true asystole. This patient has no pulse and is not breathing. It looks the same as the previous strip, doesn’t it?

  20. Figure 4-8 True Asystole

  21. Toothbrush Tachycardia • The next slide is from a man who was brushing his teeth. The arm movements jiggled the EKG wires and created what appeared to be a dangerous rhythm

  22. Figure 4-9 “Toothbrush Tachycardia” masquerading as a rhythm

  23. True Lethal Rhythm • The next slide is a true rhythm. Looks a lot like the previous strip, doesn’t it?

  24. Figure 4-10 Ventricular Tachycardia, a potentially lethal rhythm

  25. CPR Artifact • Seen during CPR • Can resemble ventricular rhythms • May cause health care personnel to think there is a rhythm when there is not

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