12-Lead ECG Acquisition and Interpretation - Australian Paramedical College
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In today's lecture, we're going to talk about 12-Lead ECG Acquisition and Interpretation. My name's Sam Willis and I'm a senior lecturer for the Australian Paramedical College. In your career as a paramedic, at some point in the assessment cycle, you are going to need to try and rule out whether the patient is presenting with signs and symptoms of a cardiac condition or whether those signs or symptoms are related to some other medical condition. Now of course one of the ways that we do this is through the use of a 12-lead ECG. Now of course the 12-lead is part of the assessment process. It does replace a physical examination and we would always teach you guys to treat the patient and not the machine.
In this session, we're going to look at the importance of a 12-lead ECG machine and monitoring in helping you guys differentiate between cardiac and non-cardiac conditions as well as talking about when to acquire the ECG because we wouldn't necessarily do it on everybody. We are going to talk you through the steps and we're also going to talk you through the steps of interpreting the ECG as well.
Now I like to use a case study to highlight the need for doing an ECG. This is a typical case study that you guys will be called to once you're state paramedics. You are called to a 65 year old male at his home address. At home, is complaining of left sided chest tightness. When you guys arrive, he's holding his chest. He appears pale and sweaty and he's telling you that he's going to die. When you undertake a 12-lead ECG, you know it is the ST-segment elevation in leads II, III, and aVF. Now of course that's a shortened version of it because these patients who are clearly having a STEMI, an ST Elevation Myocardial Infarction, they will usually be having nausea and vomiting. They will be quite anxious. They'll have blue lips. They will be telling you that they're going to die quite emphatically with emphasis and they'll usually be quite aggressive as well. It's your job to try and calm the entire situation down whilst being able to at the same time reassure the patient and give them the pharmacology that they need.
Let's put this into context then. The 12-lead ECG really is a standard part of primary practice. Historically, paramedics used to only be able to access the lead II and we'll talk about the difference between a 12-lead and a lead II later on. 12-lead ECG acquisition and interpretation has become an important part of primary care and therefore what that means is as paramedics, you need to be able to undergo a systematic approach to be able to apply and interpret the findings of the 12-lead ECG.
Now let's try and remind you guys what a 12-lead is. Imagine this image here is a picture, lots of different pictures of the heart. Imagine if you take a camera and you take a picture this way and you press the button. Then you move it and you look this way and you press the button, and you move it this way and you press the button. That's exactly what a 12-lead ECG is. It's lots of different views of the heart. Now when I say the heart, I actually mean the electrical conduction system within the heart and not the heart itself. Actually, what you're seeing here is the view of the movement of the electricity through the different regions of the heart. Now just in this image here, you have different leads. These are your 12 leads. Now ironically, it's called a 12-lead ECG because you're all seeing 12 different views of the heart, but there's actually only 10 dots, 10 electrodes that you place on the chest. That's what I find interesting but never mind, that's avoiding the situation.
Lead I is here. Lead II is here. Lead is here. aVR is the fourth lead. aVL, aVF. Lead V1, V2, V3, V4, V5, V6. Now you will notice in this ECG that they look slightly different. I'm going to show you why. Now for those of you who have got any type of understanding of ECGs, you'll see that this is a pretty bad ECG. This patient's probably quite unwell. But the purposes of me showing you this one is for those of you who have never seen a 12-lead ECG before. This is what an ECG looks like. First and foremost, you have this little square symbol here. This tells you that the paper speed is 25 millimeters per second and that the machine is being calibrated. Then you have all these different views. Remember what we said about looking in the different angles. That's what this is showing you...
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