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Certified EKG Technician Certification

Thomas Forti R.N. Certified EKG Technician Certification. The EXAM. Certified EKG Technician CET GED and 60 HRs of training 110 Questions (100 Scored) 110 minuets Web exam Score given following the exam Don ’ t spend too much time on one question

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Certified EKG Technician Certification

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  1. Thomas Forti R.N. Certified EKG Technician Certification

  2. The EXAM • Certified EKG Technician • CET • GED and 60 HRs of training • 110 Questions (100 Scored) • 110 minuets Web exam • Score given following the exam • Don’t spend too much time on one question • Try and figure out the answers before reading the answers • Eliminate incorrect answer to try and figure out correct answer

  3. HIPAA • The Health Insurance Portability and Accountability Act of 1996 • Patient has right to confidentiality • Safeguards to ensure that an individual's health information is used only for purposes related to treatment, payment, or healthcare operations • You are responsible for this when at work.

  4. HIPAA • Medicinal information needs to be sent via secure (encrypted) pathways • Best way is to personally deliver the information (Handing the MD the EKG) • Not leaving it in a mail box where someone else could view it. • Keep work area clear of patient information when you walk away

  5. Protected Health information • Any information about • Health status • Health care services • Payment • Patient identifiers • Social security • Hone numbers • Address • Treatment • Assessment • Test results • Diagnoses • Medications • During • Direct contact • Phone calls • Faxes • Emails

  6. Anatomy and Physiology • 4 Chambers of the Heart • Right and Left Atria • Right and Left Ventricle • Sepal wall separate right from left sides • Three layers of the heart • Endocardium • Myocardium • Epicardium • Heart is in a sac called • Pericardium AKA Pericardial Sac • Provided protection and lubrication

  7. Anatomy and Physiology • Four Valves of the heart • Tricuspid and Mitral • Between the atria and ventricle • Pulmonary and Aortic • Blood exits heart • Chordae Tendineae • Provide support to A-V valves to prevent regurgitation (incompetence)

  8. Anatomy and Physiology • Coronary Arteries • Vessels that supply blood to the myocardium • Occur during ventricular diastole • Normal perfusion to body occurs during systole • RCA • Supply right ventricle and inferior wall of left ventricle (bottom) • Left Main Splits to • Circumflex • Supplies blood to posterior (back) and lateral (side) • LAD • Supplies blood to anterior and Left ventricle • Collateral circulation • Compensation for loss of O2 in other areas

  9. Conduction System • Controls the synchronous, rhythmic contraction of the heart muscle • SA Node • Sinoatrial node • 60-100 BPM • Primary pacemaker of heart • Right Atria • Initiates atria contraction • Shows as P wave on EKG tracing • Internodal Pathways • Tracts that the impulse takes from SA-AV node

  10. Conduction System • AV node • Atrioventricular node • 40-60 BPM • Connects Atria to Ventricle • Impulse pulses here before heading to ventricles • PR interval • Bundle of His • Splits impulse to RBBB and LBBB • Sits in the Interventricular septum • Purkinje Fibers • Initiates myocardial contraction • 20-40 BPM

  11. EKG Theory • Measures electrical energy as it travels through the heart • Records as energy over time • Millivolts and Seconds • EKG paper has small squares • 1mm x 1mm • 5 small boxes = 5mm = 1 large box • Tracings are made by a stylus • 1mm on y axis = 0.1mv • 1mm on x axis = 40ms or 0.04 seconds • 1ms = 0.001 seconds

  12. EKG Theory • EKG paper speed is 25 mm/sec • 50mm/sec if rhythm is too fast • Only change paper speed if ordered by MD • Standard Amplitude • Amplitude is change over a period of time • 10mm = 1mv • Gain is used to increase amplitude (size) • Calibration box • At beginning of lead • Speed and amplitude • Standard is 10mm tall and 5mm wide • Gain of 1 = 10mm, ½ = 5mm, 2 = 20mm • 25mm/sec = 5mm, 50mm/sec = 10mm

  13. EKG Theory • Refer to user manual and hospital policy • For paper type • Cleaning (keypad, wires machine) • Daily user test • Correct power supply • Bio-engineer will calibrate machine if needed

  14. EKG Theory • Einthoven’s triangle • Willem Einthoven • Discover everything basic of EKGs • Bi-Polar Leads • I, II, III • Unipolar leads • V1-V6 • Augmented leads • avF, avR, avF

  15. Calculating Heart Rates • 1500 method • Atria rate- count the P-P interval • Small boxes between the P waves • Ventricle rate- count the R-R interval • Small boxes between the R waves • 1500/boxes • Sequence method • AKA 300 method • Count the large boxes between the R-R waves and • 300/boxes • 300, 150, 100, 75, 60, 50

  16. Calculating Heart Rates • 6 second rule • Good for estimating rate if R-R intervals are not regular • Count QRS complexes in 6 second strip and multiply by 10 • Marks under tracing indicate 3 seconds

  17. Artifact • Wandering baseline • Most common cause is respirations • Move electrodes off torso and onto wrists and ankles • Have patient relax and breath slowly • Seizures • Large artifact • Seizures must be controlled before EKG can be done • Dry Skin • Electrodes might now adhere • Use Benzoin to promote adhesion • Abrade the skin

  18. Artifact • Wet Skin • Dry skin • Use Benzoin to promote adhesion • Cold patient • Warm patient with blanket • May have to do EKG with artifact • Dry Gel • Use new electrodes • Cell Phones • Turn them off, remove and place aside • Can look like p waves often like A-flutter • Medical devices • Turn off or move away from EKG patient • Be careful in the ER or ICU

  19. Lead Locations • 3 Lead • White- Right Shoulder or clavicle area • Black- left shoulder or clavicle area • Red- Left lower abdomen area • Green- Right lower abdomen area • 5 Lead • White- right sternum/clavicle area • Black- Left sternum/clavicle area • Red- Left lower thoracic area • Green- Right lower thoracic area • Brown- Just below and to the right of bottom of sternum

  20. Lead Locations • Precordial Leads • V1- 4th ICS, Right of Sternum • V2- 4th ICS, Left of sternum • V3- Between V2/V4 • V4- 5th ICS, midclavicular • V5- 5th ICS, between V4/V6 • V6- 5th ICS, midaxillary • Right precordial leads • Reverse V leads

  21. Lead Locations • Posterior Leads • V7- Left posterior axillary line • V8- Left midscapular line • V9- left of spine • Stress test • Limb electrodes go on torso

  22. Post EKG • Check leads for deflection direction • Check leads for artifact • Check that patient identifiers are on EKG • Name • DOB • Medical record number • Upload EKG Via hospital policy • Mount EKG or strip per hospital policy • Hole punch, scan or stick onto mounting paper

  23. Measuring EKG’s • Know how to be able to measure • P-P interval • Time between Atria contractions • R-R interval • Time between Ventricle contractions • PR interval • Time from SA to ventricles • 0.12-0.2 seconds • QRS • Time for ventricles to depolarize • 0.06-0.12 seconds

  24. Parts of Waves • Positive • Anything above isoelectric line • Negative • Anything below isoelectric line • PR segment • Time impulse travels through AV node • End or P to beginning of QRS • ST segment • Time it take for ventricles to repolarize • End of QRS to end of T wave

  25. Parts of Waves • J Point • Point when ventricles depolarize and ventricle repolarize • End of QRS • QT interval • Time it takes ventricles to depolarize and repolarize

  26. Sinus Rhythms • P wave resent • P wave upright and rounded • QRS complex narrow • 80-120 milliseconds • PR 120-200 milliseconds • Regular Sinus Rhythm • Rate 60-100 • Sinus Bradycardia • Rate less then 60 • Sinus Tachycardia • Rate greater then 100 • Sinus Arrhythmia • Rate around 60-100 • Rhythm is irregular

  27. Atria Rhythms • P waves abnormal shaped or absent • QRS complexes narrow • Atrial Fibrillations • No P waves, No PR interval • Rate 60-100 • Irregularly irregular • Atrial Fibrillation with Rapid Ventricular • No P waves, No PR interval • Rate greater then 100 • Irregularly irregular • Atrial Flutter • P waves = Flutter waves (abnormal P waves) • Rate varies • Regular • Supraventricular SVT • P waves often NOT seen • Regular • Premature Atrial Complex PAC • P wave abnormal • QRS follows P wave • NSR with PAC

  28. Junctional Rhythms • Starts at AV node or Bundle of His • P wave absent or abnormal (inverted) • QRS narrow or above 120 milliseconds • Junctional Rhythm • P-wave absent or abnormal • Rate 40-60 • JunctionalBradycardia • Rate less then 40 • Accelerated Junctional Rhythm • Rate 60-100 • Junctional Tachycardia • Rate above 100

  29. Ventricle Rhythms • QRS complex wide • Idioventricular Rhythm • Wide QRS complexes • Rate 20-40 • Ventricular tachycardia • Monomorphic • Wide QRS with rate above 120 • Complexes look identical • Polymorphic • Complexes have different amplitude

  30. Ventricular Rhythms • Ventricular Fibrillation • No identifiable waves • Asystole • Absence of electrical activity in the heart • Premature Ventricular Complex • Wide QRS, absent P waves • R wave opposite direction of T wave • NSR with PVC • Multifocal PVCs • Different shaped PVCs • Patterns – Bigeminy, Trigemity (every other or 3rd)

  31. Heart Blocks • Impulse is delayed or blocked as it travels to the ventricles • 1st degree • PR interval greater then 200 milliseconds • 2nd degree type 1 • PR interval elongates until dropped QRS complex • 2nd degree type 2 • PR interval normal if present • Dropped QRS complex without warning • 3rd degree • Complete lack of association between the atria and ventricles • P waves present at normal rate • QRS waves at rate of Junctional rate or idioventricle • Could be wide or narrow

  32. Injury • Ischemia • ST segment depression • T wave inversion • Injury • ST elevation • 1mm in limb leads • 2mm in precordial leads • Infarction • ST elevation will return to baseline • Pathological Q waves develop • Pathological Q waves can indicate MI

  33. Lead Locations for MI

  34. ST segment Morphology • Draw line from J point to top of T wave • Convex • ST segment is above line • Can be Ischemia STEMI • Concave • ST segment is below line • Can be ischemia but often benign

  35. ST segment sloping

  36. T Wave • T wave is peaked • T wave is Hyperacute • Hight is greater then ½ the QRS • T wave elongates

  37. Cardiac Compromise • Tachy or brady • Pallor • Diaphoresis • Decrease in BP • Breathing problems • Anxiety or confusion • Cyanosis • Chest pain or tightness • Back, arm, jaw pain • Nausea and vomiting • Lightheadedness • Weakness • Syncope

  38. Left-threating arrhythmias • Ventricular tachycardia • Check Pulse • Ventricular fibrillation • Call for help • Start CPR • Use AED • Asystole • Check in 2 leads • Call for help • Start CPR • Bradycardia • Call for help • Check Vitals • Prepare patient for pacing • Tachycardia • Call for help • Check vitals • Cardioversion

  39. Pacemakers • Paced Ventricular • Paced Atrial-Ventricular

  40. Patient Care • Responsible for knowing patients • Medical History • Smoking, alcohol, drugs, stress, exercise, nutrition, work environment, family history, marital status, children • Past medical conditions • Stroke, MI, Aneurysm, murmurs, PE, DVTs, Heart failure, hypertension, COPD, CHF • Current Complains • Pain, SOB, Edema, Palpitations, Fainting, Weakness • Surgical History • What, when, complications (more details if cardiac) • Medication List (also allergies) • Currently taking and recently stopped (last month or 2) • Include OTC medications, birth control, erectile dysfunction

  41. Patient Care • Explain procedures fully with easy to understand terms • Explain purpose, length, steps of procedure • Preparation if test isn’t for today • Allow them to ask questions

  42. Patient Care • EKG • Allow physician to assess the electrical activity of the heart • Non-invasive, Painless • Around 10 mins • What the electrodes are for • Empty pockets, relax, lay flat avoid moring or talking

  43. Patient Care • Holter • Monitors activity for 24-72 hours • Instruct patient to bathe rior to appointment • Pt can not remove electrodes or get device wet during time • Loose fitting clothing to help prevent artifact • Notify if irritation occurs from electrodes • Normal daily activity • Including work exercise and sleep • Journal with date time and duration of any symptoms • Lightheadedness, palpations, chest pain, SOB • Note when medications taken, physical activity and sleeping • Patient to call physician office if electrodes fall off • Electrodes get replaced by Tech NOT patient • Batteries get changed by Tech NOT patient • Electrodes get moved by Tech • Call 911 for serious symptoms

  44. Patient Care • Stress Test • Used to determine how the heart function under increased workload from exercise • Take about 10 mins • Electrodes and Blood pressure during test • Baseline EKG prior and end of test • Test goes until • Symptoms occur • Lightheadedness, dizziness, SOB, Chest pain • Target heart rate reached or physician orders test to end • Patient not to eat, drink or smoke 3 hours prior • Continue normal medication unless instructed by physician to hold medication • Wear clothing and shoes for exercising

  45. Patient Care • Stress Test • Monitor for • Vital Sings • Arrhythmias • Cardiopulmonary compromise • Heart rate • Complications • Most common is hypotension and arrhythmias • Stop and let patient rest • Lay patient down • Report change to physician

  46. Patient Care • Telemetry • Continuous monitoring of electrical system • Within hospital • Notify staff if symptoms occur

  47. Vitals • Check Pulse • Adult- Radial • Child- Brachial • Apex use stethoscope • 5th ICS midclavicular • Pulse oximeter • Used to determine amount of oxygen in blood • Normal is above 95% • Cant read if: cold hands, colored nails, edema, fake nails

  48. Vitals

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