Clinicals Chapter 37 Worksheet ECG/EKG

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ECG/EKG

electrocardiogram

Define electrocardiogram

A record of the electrical activity of the heart

Many physicians include the EKG as part of a:

routine physical examination

What age to patients start getting routine EKG/ECG?

40 years of age, or if they have a family history of cardiac disease.

An EKG/ECG measures?

The amount of electrical activity produced by the heart
The time necessary for hte electrical impulses to travel through the heart during each heartbeat

Name 5 reasons for getting an ECG:

1. Detect myocardial ischemia
2. Estimate damage to the myocardium, caused by myocardial infartion
3. Detect & evaluate cardiac arrhythmia
4. Asses effects of cardiac medication on the heart
5. Determine if electrolyte imbalance is present.

The MA who records the EKG must have special knowlege and skills in these aspects of the procedure: (5)

1. Patient preperation
2. Operation of the electrocardiograph machine
3. Elimination of artifacts
4. Know how to mount and lable the ECG
5. Maintenance and care of the instrument

The pacemaker or _________ sends out an electrical impulse that begins and regulates the heart beat.

SA Node (sinoatrial node)

During depolarization of the heart, the myocardial cells ____________ causing the heart muscle to ___________ the blood from chanber to chamber and through the lungs.

1. contract
2. pump

The heart "recovers" during _______________

repolarization

The heart "relaxes" briefly ________________, before the SA node sends another impulse.

polarization

What is the electrical process called (1), and what does it represent (2)?

1. Cardiac cycle
2. heartbeat

The EKG records the _______________(1) that caused the contraction, or ___________(2) and the relaxation, or ___________(3) of the ____________(4) and ____________(5).

1. Electrical activity
2. Systole
3. Diastole
4. Atria
5. Ventricles

The baseline, or __________(1), line is the flat line that ____________ (2) the various waves w hen there is no current flowing in the heart.

1. Isoelectric
2. Separates

What does the P wave represent?

Depolarization of the atria

What does the QRS wave represent?

Ventricular depolarization, and is measured from the beginning of the first wave of QRS to the end of the last wave of the QRS complex.

What does the T wave represent?

Ventricular repolarization

What do the horizontal lines on an EKG/ECG measure?

Time

What do the vertical lines on an EKG/ECG measure?

Voltage

A single-channel machine reads _________ lead at a time.

One

The most common multi-channel machine used in a physician's office is the __________ channel machine.

3

The standard EKG consists of ________ (1) sensors that record _____(2) leads of the heart's electrical activity from different angles.

1. 10
2. 12

The electrical impulses given off by the heart are picked up by the _____________ (1) and conducted into the machine through (2) __________

1. Electrodes
2. Lead wires

The limb leads are placed on the fleshy, non-muscular area of the __________(1) and _______(2).

1. Upper arms
2. Lower legs

What are the limb leads labled?

1. RA
2. LA
3. RL
4. LL

The _________lead is used for a reference point only.

Right leg

The first three leads are called I, II, and III. They are known as _________ because they each use two limb electrodes simultaneously.

bipolar leads

After leads I, II, and III, the next 3 leads are ________(1)(added to) and are _________(2) leads

1. augmented
2. unipolar

The 3 augmented leads are designated:

1. aVR
2. aVL
3. aVF

The av stands for:

augmented voltage

What does the r, L and F stand for in the aVL, aVR and aVF?

right
left
foot

What are the chest leads also known as (3)

1. V leads
2. Precordial leads
3. C leads

What is the placement of V1?

4th intercostal space at right margin of the sternum

What is the placement of V2?

4th intercostal space at left margin of sternum

What is the placement of V3?

Midway between position 2 and position 4

What is the placement of V4?

5th intercostal space at junction of left midclavicular line

What is the placement of V5?

At horizontal level of portion 4 at the left anterior axillary line.

What is the placement of V6?

At horizontal level of position 4 at left midaxillary line.

What are the 4 main artifacts?

Somatic Tremor (aka muscle tremor)
AC Interference
Wandering Baseline
Interrupted Baseline

What is the cause of a somatic tremor?

Patient apprehension, or uncomfortable. Involuntary muscle movement or voluntary muscle movement. Like coughing talking etc., or Parkinsons or other disorders.

How do you correct a somatic tremor?

Ease your patients apprehensions. Ask them to be quiet and calm. Have them take a deep breath and put their hands under their buttocks. Use pillows under head and knees.

What can cause AC Interference?

Poorly grounded equipment, presence of other electrical equipment. Wiring in the floor, ceiling, or walls. Crossed lead wires, or lead wires not following the contour of the body.

How do you correct AC Interference?

Make sure equipment plugged in and grounded correctly, move machine away from walls, straighten lead wires and make sure the wires are following the body contour. Have the patient remove any metal such as watches, earrings or hair pins.

What causes a wandering baseline?

Electrodes applied too loosely, or too tightly.
An inappropriate amount of electrolyte, or poor quality electrolyte.
Presence of lotions, oils or creams on the patients skin.

How do you correct a wandering baseline?

Make sure there is equal tension on all 4 limb leads and metal tips should be firmly attached to the electrodes and the cable attached to patient should not have tension on it or dangling, causing pulling on the electrode. Make sure electrodes have the same amount of good quality electrolyte,
Celanpatients skin of all lotions, oils or creams.

What causes an interrupted baseline?

Broken cable, a lead wire that became detached from an electrode or an electrode that came off.

How do you correct an interrupted baseline?

Check for all connections and broken cables and fix the problem.

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