chapter 5 for 12 lead training -making sense of the 12 lead-
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BASE HOSPITAL GROUPONTARIO
Chapter 5 for 12 Lead Training
-Making sense of the 12 Lead-
Ontario Base Hospital GroupEducation Subcommittee
2008
TIME IS MUSCLE
OBHG Education Subcommittee
Making sense of the 12 Lead
REVIEWERS/CONTRIBUTORSNeil Freckleton, AEMCA, ACPHamilton Base Hospital
Jim Scott, AEMCA, PCPSault Area Hospital
Ed Ouston, AEMCA, ACPOttawa Base Hospital
Laura McCleary, AEMCA, ACPSOCPC
Tim Dodd, AEMCA, ACPHamilton Base Hospital
Dr. Rick Verbeek, Medical DirectorSOCPC2008 Ontario Base Hospital Group
AUTHORGreg Soto, BEd, BA, ACPNiagara Base Hospital
OBHG Education Subcommittee
Chapter 5 Objectives Describe how the ECG printout
relates to time Discuss the benefits and
limitations of the machine analysis Locate the isoelectric line using
the calibration spike as a reference
Demonstrate how to validate a 12 Lead ECG
OBHG Education Subcommittee
Standard Hospital Printout
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Data Columns
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Content of Analysis
OBHG Education Subcommittee
Machine Analysis
Machines analyze data for a conclusion People interpret the electrocardiogram Computer may give erroneous readings Acute care providers must be able to tell the
difference
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Machine Analysis
****ACUTE MI**** This statement is displayed by the machine
when it determines the presence of ST elevation in accordance with it’s criteria.
Local protocols must be followed upon seeing this message
OBHG Education Subcommittee
Isoelectric Line Basis for all voltage
measurements ST segment elevation/
depression measured from isoelectric line
Usually found at the bottom of calibration bar (arrow)
Best to measure from the TP Segment
OBHG Education Subcommittee
12-Lead Validation
Lead I – P wave, QRS, and T wave is normally upright (positive) deflection
aVR – almost always downward (negative) deflection
Limb lead reversal can lead to an ECG misdiagnosis often referred to as “heart disease of electrocardiograph origin”
Can have significant impact on subsequent care of the patient
OBHG Education Subcommittee
12-Lead Validation
Normal
Lead I – upright aVR - downward
Lead I
OBHG Education Subcommittee
12-Lead Validation
RA/LA Reversed
Lead I – downward aVR – upright
aVR
Lead I
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Normal R – wave Progression
OBHG Education Subcommittee
Normal R – wave Progression
OBHG Education Subcommittee
Precordial Lead Reversal
BASE HOSPITAL GROUPONTARIO
QUESTIONS?
BASE HOSPITAL GROUPONTARIO
Well Done!
Education Subcommittee
START QUIT
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