1 / 21

Chapter 8 for 12 Lead Training -The 15 Lead ECG-

Chapter 8 for 12 Lead Training -The 15 Lead ECG-. Ontario Base Hospital Group Education Subcommittee 2008. TIME IS MUSCLE. The 15 Lead ECG. REVIEWERS/CONTRIBUTORS Neil Freckleton, AEMCA, ACP Hamilton Base Hospital Jim Scott, AEMCA, PCP Sault Area Hospital Ed Ouston, AEMCA, ACP

parry
Download Presentation

Chapter 8 for 12 Lead Training -The 15 Lead ECG-

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 8 for 12 Lead Training-The 15 Lead ECG- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE

  2. The 15 Lead ECG 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 8 - Objectives • Describe the benefits of acquiring a 15-lead ECG • Describe the proper lead placement for Leads V4R, V8, and V9 • Describe the hemodynamic problems associated with a right ventricular infarction • List 3 clinical signs of RVI • On a 15-lead ECG, recognize ECG changes for a posterior and right ventricular MI

  4. Why a 15-Lead ECG? • Used when a patient has an Inferior STEMI or suspected Posterior STEMI (reciprocal changes with ST depression in V1/V2) • Can confirm Posterior MI (usually associated with an Inferior MI • Can suggest RVMI which is a larger and more complicated Inferior MI

  5. Acquiring the 15-Lead (V4R) • Run standard 12-lead • Lead V4R: 5th IC space midclavicular on right side • Same as left side V4 • Attach V4 wire to the V4R position

  6. Acquiring a 15-Lead (V8, V9) • Posterior leads • V8: 5th IC space midscapular line • V9 goes between V8 and the spine • Place Lead V5 wire on V8 and V6 wire on V9 • Acquire the second 12-lead • Re-label the new leads

  7. Right Ventricular Infarction • RV gets blood supply from the RCA • Up to 50% of inferior MI will have RVI • RV is preload dependant for Cardiac Output • Nitrates cause preload reduction; thus use nitrates with extreme caution • Hypotension in RVMI often responds well to IV fluid bolus (increase in preload) • May require 1 liter or more IV fluid bolus for hypotension

  8. Clinical Signs of RVI The TRIAD: • Jugular vein distention (JVD) • Hypotension, either presenting or following nitro administration • Clear lung sounds

  9. Right Coronary Artery • Inferior wall of LV • Right ventricle • Posterior LV • Posterior fascicle of LBB • SA and AV node • 2nd deg I common

  10. Posterior view

  11. 15-Lead ECG

  12. 15 Lead Practice Cases

  13. Inferior/Posterior/RVI

  14. Inferior

  15. Inferior - Posterior

  16. None

  17. Inferior/Posterior

  18. None

  19. Indications - 15 Lead ECG • Any Inferior AMI (but especially accompanied by ST-depression in V1 to V3) • ST-depression in V1 – V3 on its own in symptomatic ACS patient

  20. QUESTIONS?

  21. START QUIT Well Done! Education Subcommittee

More Related