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

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Standard Hospital Printout

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Data Columns

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Content of Analysis

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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

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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

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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

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12-Lead Validation

Normal

Lead I – upright aVR - downward

Lead I

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12-Lead Validation

RA/LA Reversed

Lead I – downward aVR – upright

aVR

Lead I

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Normal R – wave Progression

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Normal R – wave Progression

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Precordial Lead Reversal

BASE HOSPITAL GROUPONTARIO

QUESTIONS?

BASE HOSPITAL GROUPONTARIO

Well Done!

Education Subcommittee

START QUIT