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.

 

Certification Requirements:

 

  • Maintain knowledge of the indications, contraindications technique, and possible complications of the procedure.  Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations or other mechanisms as deemed appropriate by medical control.