ELECTROCARDIOGRAM (ECG or EKG) Is non invasive diagnostic procedure that measures the electrical activity of your heart.

The heart generates electrical signal which flows out from your heart through your body. Small electrical sensors called electrodes that are put on your skin can sense the electricity that began in your heart. An ECG is used to: Diagnose heart attacks and rhythm problems Offer clues about other heart conditions and conditions not primarily related to the heart Detect conditions that alter the bodys balance of electrolytes (eg, potassium and calcium) Detect other problems, such as overdoses of certain drugs ASSESSMENT Chest pain - need to note the TIMING, QUALITY, QUANTITY, LOCATION, PRECIPITATING OR AGGRAVATING FACTORS, RELIEVING FATORS. How is an ECG (EKG) performed? EKG leads are attached to the body while the patient lies flat on a bed or table. Leads are attached to each extremity (four total) and to six pre-defined positions on the front of the chest. A small amount of gel is applied to the skin, which allows the electrical impulses of the heart to be more easily transmitted to the EKG leads. The leads are attached by small suction cups, Velcro straps, or by small adhesive patches attached loosely to the skin. The test takes about five minutes and is painless. In some instances, men may require the shaving of a small amount of chest hair to obtain optimal contact between the leads and the skin.

What is measured or can be detected on the ECG (EKG)? 1. The underlying rate and rhythm mechanism of the heart. 2. The orientation of the heart (how it is placed) in the chest cavity. 3. Evidence of increased thickness (hypertrophy) of the heart muscle. 4. Evidence of damage to the various parts of the heart muscle. 5. Evidence of acutely impaired blood flow to the heart muscle. 6. Patterns of abnormal electric activity that may predispose the patient to abnormal cardiac rhythm disturbances.

When is an ECG (EKG) performed? 1. As part of a routine physical examination or screening evaluation. 2. As part of a cardiac exercise stress test. 3. As part of the evaluation of symptoms of chest pain, shortness of breath,dizziness or fainting, palpitations, or What conditions may be diagnosed with an ECG (EKG)? 1. Abnormally fast or irregular heart rhythms. 2. Abnormally slow heart rhythms. 3. Abnormal conduction of cardiac impulses, which may suggest underlying cardiac or metabolic disorders. 4. Evidence of the occurrence of a prior heart attack (myocardial infarction). 5. Evidence of an evolving, acute heart attack. 6. Evidence of an acute impairment to blood flow to the heart during an episode of a threatened heart attack (unstable angina). 7. Adverse effects on the heart from various heart diseases or systemic diseases (such as high blood pressure, thyroid conditions, etc.). 8. Adverse effects on the heart from certain lung conditions (such asemphysema, pulmonary embolus [blood clots to lung]). 9. Certain congenital heart abnormalities. What Affects the Test? Reasons you may not be able to have the test or why the results may not be helpful include: Not having the electrodes securely attached to your skin. Moving or talking during the test. Exercising before the test. Being anxious or breathing very deeply or rapidly

Patient Positioning Place the patient in a supine or semi-Fowlers position. If the patient cannot tolerate being flat, you can do the ECG in a more upright position. Instruct the patient to place their arms down by their side and to relax their shoulders. Make sure the patients legs are uncrossed. Move any electrical devices, such as cell phones, away from the patient as they may interfere with the machine. Skin Preparation Dry the skin if its moist or diaphoretic. Shave any hair that interferes with electrode placement. This will ensure a better electrode contact with the skin. Rub an alcohol prep pad or benzoin tincture on the skin to remove any oils and help with electrode adhesion. Electrode Application Check the electrodes to make sure the gel is still moist. Do not place the electrodes over bones. Do not place the electrodes over areas where there is a lot of muscle movement.

How to Prepare for the Test Make sure your health care provider knows about all the medications you are taking, as some can interfere with test results. Exercising or drinking cold water immediately before an ECG may cause false results. An ECG is usually the first test done to determine whether a person has heart disease. Your doctor may order this test if: You have chest pain or palpitations You are scheduled for surgery You have had heart problems in the past You have a strong history of heart disease in the family

Color: Red Yellow Green Black Red Yellow Green Brown Black Violet
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Connect to: Right Wrist / AVr Left Wrist / AVL Left Ankle / AVf Right Ankle / Null V1 - 4 intercostal space, right sternal border. th V2 - 4 intercostal space, left sternal border. V3 - Between V2 and V4. th V4 - 5 intercostal space, left midclavicular line. th V5 - 5 intercostal space, left anterior axillary line. th V6 - 5 intercostal space, left mid axillary line.

Answers: TIMING, QUALITY, QUANTITY, LOCATION, PRECIPITATING OR AGGRAVATING FACTORS, RELIEVING FATORS. Answer: ELECTRODES What color? Red Yellow Green Black What color? Red Yellow Green Brown Black Violet Label and location of the limb leads? AVr / Right Wrist AVL / Left Wrist AVf / Left Ankle Null / Right Ankle Label and Location of the chest leads? V1 - 4 intercostal space, right sternal border. th V2 - 4 intercostal space, left sternal border. V3 - Between V2 and V4. th V4 - 5 intercostal space, left midclavicular line. th V5 - 5 intercostal space, left anterior axillary line. th V6 - 5 intercostal space, left mid axillary line.
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Date: Feb 8, 2014 Setting: Emergency Room Head Nurse: John Michael Fernandez Staff Nurses: Arcel John Delgado Rhea Louise Suga

OBJECTIVES:

To be able to enhance knowledge and skills of the students regarding ECG placement. To be able to test the knowledge of the students about the procedure performed. To be able to evaluate their learning by giving a quiz to the students.

PLAN OF ACTIVITIES:
8:00 8:05 am Prayer 8:05 8:10 am Attendance and Grooming 8:10 8:30 am Lecture 8:30 8:50 am Demonstration of ECG placement 8:50 9:30 am Return Demonstration of ECG placement 9:30 10:00 am Quiz