2015 Trumbull Memorial Hospital Demo

112 / 222

112
EMR EMT AEMT Paramedic Extended
12 Lead ECG
Steps Performed?
Yes No
1. Prepare ECG monitor and connect patient cable with electrodes. ☐ ☐
2. Enter the required patient information into the 12-Lead ECG device.
 First and Last Name
 Date of Birth
 Age
 Gender
 Cardiologist (if able to enter)
☐ ☐
3. Expose chest (respecting modesty) and prep as necessary.
Poor quality can be caused by lack of skin preparation. Use a gauze pad to vigorously rub the
site, to remove the outer layer of dead skin. Dry the site. Alcohol preps can remove creams or
lotions. Remove excess hair as needed.
☐ ☐
4. Attach limb leads on or near the limbs. Avoid attaching to the torso.
Attaching leads to the torso produces a cleaner rhythm, but may limit evaluation of ECG. Some
changes that may occur are:
 Cardiac axis shift to the right
 R wave becomes smaller in Lead I
 Less prominent Q waves in inferior leads
☐ ☐
5. Apply chest leads and extremity leads using the following landmarks: ☐ ☐
 RA – Right arm
 LA – Left arm
 RL – Right leg
 LL – Left leg
 V1 – 4th ICS at sternal border
 V2 – 4th ICS at sternal border
 V3 – Directly between V2 and V4
 V4 – 5th ICS at midclavicular line
 V5 – Level with V4 at anterior axillary line
 V6 – Level with V5 at midaxillary line
6. Instruct patient to remain still. ☐ ☐
7. Press the appropriate button to acquire the 12-Lead ECG. ☐ ☐
8. If the provider is an EMT or AEMT without a Paramedic present, transmit the 12-Lead.
If a Paramedic is present and the 12-Lead shows STEMI or a life threatening
arrhythmia, transmit to the receiving facility.
 If the Paramedic identifies a STEMI, activate the cath lab by calling the receiving facility
and identifying your unit, then stating “I have a STEMI.” Then explain the situation,
including the leads with ST elevation, and verbally activate the cath lab.
9. If the tracing displays too much artifact, consider the following: ☐ ☐
 Check cable connection
 Is the equipment functioning properly?
 Is there interference from external
electrical equipment?
 Are the electrodes dry?
 Is there poor adhesion?
 Are the cables touching a metal surface?
 Are the cables entangled or hanging?
 Is the snap connection secure?
10. Monitor the patient while continuing with the treatment protocol. ☐ ☐
12 Lead ECG