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The Electrocardiogram: Basic Concepts and Lead Monitoring Chapter 2

The Electrocardiogram: Basic Concepts and Lead Monitoring Chapter 2. Robert J. Huszar, MD Instructor Patricia L. Thomas, MBA, RCIS. Electrical Basis of the Electrocardiogram. Graphic record of magnitude and direction of electrical activities or current

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The Electrocardiogram: Basic Concepts and Lead Monitoring Chapter 2

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  1. The Electrocardiogram:Basic Concepts and Lead MonitoringChapter 2 Robert J. Huszar, MD Instructor Patricia L. Thomas, MBA, RCIS

  2. Electrical Basis of the Electrocardiogram • Graphic record of magnitude and direction of electrical activities or current • Generated by Depolarization and Repolarization

  3. Components of the Electrocardiogram • P-wave • QRS wave • T wave • Segments • PR • ST • TP • Intervals • PR • QT • R-R • J Point

  4. EKG PAPER • Vertical Lines • Dark lines are .20 second (5 mm) apart • Light lines are .04 second (1 mm) apart • Horizontal Lines • Dark Lines are 5 mm apart • Light Lines are 1mm apart • Large Square 5 x 5 mm • One Small Square 1x1 mm

  5. Artifacts • Tense or Nervous patients • Shivering from cold • Gives EKG finely or coarsely jagged appearance • Poor electrical contact with skin • Dried electrode paste or jelly

  6. Artifacts • Improperly grounded • AC-operated ECG Machine • Obtained near high tension wires, transformers or electric appliances

  7. Artifacts • Signals are poorly received over a biotelemetry system • When transmitter’s power is low because or week batteries

  8. Artifacts • During CPR • Causes regularly spaced, wide, upright waves synchronous with the downward compressions of the chest

  9. 12 Lead ECG • Six Limb or Extremity Leads • Three standards (bipolar) limb leads • Leads I, II & III • Three Augmented (unipolar) Leads • Leads aVR, aVL, & aVF • Six Precordial (unipolar) • Leads V1, V2,V3, V4, V5 & V6

  10. 12 Lead ECG • Lead I • Left arm (+) • Right arm (-) • Lead II • Right arm (-) • Left leg (+) • Lead III • Left arm (-) • Left leg (+)

  11. 12 Lead ECG • Central Terminal • Formed by connecting the extremity electrodes together which is negative • aVR • Right arm (+) • aVL • Left arm (+) • aVF • Left leg (+)

  12. 12 Lead ECG • V1 • Right of sternum in the fourth intercostal space • V2 • Left of sternum in the fourth intercostal space • V3 • Midway between V2 & V4 • V4 • Midclavicular line in the fifth intercostal space • V5 • Anterior axillary line at the same level • V6 • Midaxillary line at the same level V5

  13. THE ENDOFCHAPTER 2 Hauszar Robert, Basic Dysrhythmias, Interpretation & Management, Third Edition, Mosby, Inc. 2002, pp. 1-20. Bledsoe.Porter.Cherry.”Paramedic Care: Principles & Practice, Prentice-Hall, Inc. Volume 3. 2001. Pp. 90- 93

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