12 Lead EKG

Hi, I'm Bob pace from Charlottesville, Virginia, President of Edutainment. I've been a paramedic for over 40 years. I'm a critical care paramedic and a NASA certified EMS educator and hold a master's degree in adult education from Colorado State University. Today we're going to be talking about the importance of a 12 lead EKG and a 15 lead EKG. The importance of a 12 lead 15 lead EKG cannot be overstated. The 12 lead EKG is the triage tool for acute coronary syndromes. So if you're faced with a patient with symptomology of an mi, and that could be almost anything, I like to say if the patient has a pulsing or problem between nose and navel and it's related to Cardiovascular, then a 12 lead EKG should be acquired right off the bat. In fact, if you want to have a great standard to go by, it's recognition activation, intervention. Recognition means from the point of first medical contact, whoever that may be, to the first 12 lead acquired should be less than five minutes. And you do this by leading into it. You got a pulsating problem seeing nose and navel with a priority symptom like chest pain, shortness of breath, don't feel good, unconsciousness, or any other thing that could be possibly related to acute coronary syndromes. And a 12 lead EKG should be acquired immediately. So you quickly say, well, my partner is going to hook you up to an ekg. It's important we take a picture of your heart right now to find out what's going on. Immediately acquire the 12 lead EKG. The only 12 lead that can't be read is one that's never been run. And so by the Same token, a 12 lead EKG run incorrectly must never be read. So we must be diligent in acquiring the 12 lead EKG the correct way. Perhaps the best location to put the limb leads and the upper extremities is anywhere as long as you're off the shoulder. But keep it above the elbow, anything below the elbow. Whenever the patient, you tell them to hold still, the patient is going to grab something and when they do, they'll tighten their forearm muscles. And in doing so, if the leads are located there, you'll get artifact due to muscle tremor. When it comes to the lower extremities, you'll want to put the electrode below the inguinal ligament. That's where your legs attach to your body. So a good place on the calf of the thigh will be just fine. The limb leads go on the limbs for two reasons, angle and amplitude. If the limb leads are not on the limbs, then the 12 lead is not considered to be diagnostic. It would be considered a monitor quality 12 lead. They do these on occasion when people are doing treadmill tests at the hospital. However, for the purposes of prehospital, we're there to run a diagnostic 12 lead as soon as we can. In review. The 12 lead EKG is diagnostic when the limb leads are correctly placed on the limbs and the skin is prepped so that there is no artifact due to muscle tremor or trying to read through dead skin. Now, upon running the 12 lead EKG, you must inspect the 12 lead EKG for ST segment elevation and two or more related LES is called a stemi. And so that is your first order of business in the recognition phase. The 12 lead EKG has a notorious lack of sensitivity, which means half the time people could be having a heart attack but not show stimming on the 12 lead. The inferior, the septal, the anterior and the lateral are the primary areas seen by the 12 lead. In order for the 12 lead to be accurate in diagnosing a stemi, the leads have to be right on top of where the damage is occurring in the heart. That's why we meticulously place the V leads in the certain locations that they go. But if the 12 leads normal, it could be that it may be too soon. And so that's why we do serial 12 leads. So on normal 12 leads, we're going to run another one to see what's going on.