12 Lead

 

Clinical Indications:

 

  • Suspected cardiac patient.
  • Suspected tricyclic overdose.
  • Electrical injuries.
  • Syncope.

 

Procedure:

 

  • Assess patient and monitor cardiac status.
  • Administer Oxygen as patient condition warrants.
  • If patient is unstable, definitive treatment is the priority. If patient is stable or stabilized after treatment, perform a 12-Lead EKG.
  • Prepare EKG monitor and connect patient cable with electrodes.
  • Enter the required patient information (patient name, etc.) into the EKG device.
  • Expose chest and prep as necessary. Modesty of the patient should be respected.
  • Apply chest leads and extremity leads using the following landmarks:

 

 

    • RA: Right arm
    • LA: Left arm
    • RL: Right leg
    • LL: Left leg
    • V1: 4th intercostal space at right sternal border
    • V2: 4th intercostal space at left sternal border
    • V3: Directly between V2 and V4
    • V4: 5th intercostal space at midclavicular line
    • V5: Level with V4 at left anterior axillary line
    • V6: Level with V5 at left midaxillary line

 

 

  • Instruct the patient to remain still.
  • Press the appropriate button to acquire the 12-Lead EKG.
  • If the monitor detects signal noise (such as patient motion or a disconnected electrode), the lead acquisition will be interrupted until the noise is removed.
  • If an inferior infarct is suspected, obtain a right-sided and posterior (15-Lead) EKG.
  • For a 15-Lead EKG apply chest leads using the following landmarks:
    • V7: Use lead V4 and place on left side 5th intercostal space at midclavicular line
    • V8: Use lead V5 and place under left scapula at midclavicular line
    • V9: Use lead V6 and place under tip of left scapula

 

  • Once acquired, transmit the 12-Lead EKG data by fax to the appropriate hospital and notify the hospital of the 12- Lead EKG transmission. Do not transmit the 15-Lead EKG.
  • Monitor the patient while continuing with the treatment protocol.
  • Download data as per guidelines and attach a copy of the EKG’s to the patient care report (PCR).
  • Document the procedure, time, and results on/with the PCR.