Control panel ekg

V2

4th intercostal space, left sternal border

V1

4th intercostal space, right sternal border

V4

5th intercostal space, left of the midclavicular line

Main power switch (off/on)

Allow for a warm-up time (as specified by the manufacturer) before using.

Sensitivity control

Allows the operator to increase or decrease the recording size to enlarge or shrink the deflections to fit on the paper. When changing from the international standard of sensitivity 1 to sensitivity 1⁄2 or sensitivity 2, the operator must include a standard for the interpreter information.

Standard button

Allows verification of calibration to the international standard.

ten sensors, or electrodes

Are placed on bare skin to record

white coat" syndrome

Be aware that many patients have elevated blood pressure readings just from being in a medical environment. This phenomenon is referred to as "white coat" syndrome.

Stylus control

Centers the recording in the middle of the page or the center of each channel by moving the stylus.

60-cycle or AC (alternating current) interference

Electrical current in wires and equipment may be picked up by the patient's body and the recording machine. This appears in the recording as small regular spikes or static, and is caused by improper grounding, nearby electrical equipment in use, or twisted and coiled lead wires. Ground the machine properly. Unplug other electrical equipment in the area. Move the machine to an interior wall outlet away from outlets containing other cables. You may have to wait until a procedure in an adjacent room, such as an X-ray, is completed (

Examples

For example, a patient in a cast up to the knee requires that both sensors be placed above the knee. If a hand and forearm are amputated, both arm sensors must be placed on the upper arm.

Stylus heat control

Increases or decreases heat and adjusts for the sharpest tracing by the stylus. This control is seen on older models, but newer machines use an ink cartridge instead of a heat stylus.

Marker

Indicates, by a code, which lead is being recorded.

Preparation for ekg

Instruct the patient to relax, breathe normally, and refrain from speaking during the procedure.

V5

Left of the anterior axillary fold, in line with V4

V6

Left of the midaxillary, in line with V4 and V5

Broken recording

Loose or broken lead wires cause the stylus to thrash erratically and to go off the page, leading to broken recording. Repair the wires, replace them, or call for service on the equipment

Newer machines

Many newer machines use an ink cartridge to supply the stylus and provide a longer-lasting printout.

V3

Midway between V2 and V4

Preparation for ekg

Prepare the patient's skin for electrodes by wiping the areas with alcohol swabs. Shave excessively hairy areas using a razor, if necessary.

time

Recorded horizontally

Voltage

Recorded vertically

Artifacts

Somatic tremor —This artifact is caused by a tense muscle or a muscle contraction, even one that you cannot see. This muscular activity causes unwanted stylus movement while the ECG is recording. It may result from patient discomfort, tension, chills, talking, or moving. Calm and reassure the patient. Suggest that the patient relax, breathe normally, and not talk. If necessary, place the patient's hands, palm side down, under the hips. This is especially helpful if the patient is not relaxed on the narrow table. This position is also best for patients with a tremor disorder. They will display the smallest number of artifacts in this position

The RL sensor

Stands for Right Leg serves as an electrical reference point and is not actually used in the recording

Lead selector

This determines from which sensors the machine will record

Record switch

This switch moves the paper at the international standard "run 25" speed (25 mm/sec). Another option is "run 50" (50 mm/sec, or twice as fast). This is used when the heart rate is so rapid that interpretation requires that it be stretched out. This is only used for detailed interpretations because it tends to waste paper and can be more difficult to read.

Artifacts in ekg

Wandering baseline —Baseline sway and baseline shift (Figure 50-11) are caused by poor sensor contact with the skin, such as when sensors are dirty or applied too tightly or too loosely, when lotion or talcum prevents good contact with the skin, or when the patient cable slips toward the floor and pulls on the lead wires. You must readjust, reapply, or clean the sensors and place the patient cable securely on the table. You may need to clean the skin with alcohol or shave chest hair to allow proper sensor skin contact.

The sternal border

border of the sternum, or breastbone

The midaxillary line

imaginary vertical line that runs from the center of the armpit.

The midclavicular line

is an imaginary vertical line that runs through the middle of the clavicle, or collarbone

The ECG

is often performed in an exam room with the patient supine (lying on the back) on the exam table.

Electrocardiogram paper

is pressure and photo sensitive and must be handled carefully. If this paper is exposed to light for long periods, the markings will fade.

anterior axillary fold

is the fold at the front of the armpit

Chest sensors

known as precordial leads

When checking the ECG machine

plug the machine into a properly grounded outlet on an interior exam room wall

"Time" markers

referred to as 3-second markers, are printed on all ECG paper. Look for them at the top of single-channel paper and between channels in multichannel paper

An intercostal space

space between ribs

The chest sensor, abbreviated with V, is used in six locations

with a number following the V, as in V1, V2, and so forth.

If you have a patient on whom you cannot place one extremity sensor as planned

you must place the sensors on both extremities symmetrically.