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Scene safety
BSi & Provide privacy
Presses ON* .

Prepares patient*
Explain the reason for ECG monitoring, reassuring the client that it allows immediate treatment
of abnormal rhythms if necessary. Explain alarms, their purpose, and possible causes such as
loose or disconnected lead wires Activity is permitted within ordered restrictions while on the
monitor
Bares patients chest
Prepares electrode sites with brisk dry rub
provide additional preparation needed for patient with excessive hair, oily or damp skin
*Check equipment for damage (i.e., fraying, bent, or broken wires). Connect lead wires to cable,
and secure the connections.
*Select electrode sites on the chest wall, considering lead to be monitored, skin condition, and
any incisions or catheters.
*Before Applies ECG electrodes
Confirms package is sealed and use by date has not passed
Attaches an electrode to each lead wire
Inspects electrode gel for moisture content
Identifies appropriate electrode sites for 3-wire cable in upper right,Upper left, lower left
torso areas; or 5-wire cable in upper right and left.
Applies electrodes flat to skin, smoothing tape outwardly.
Avoiding pressing on center of electrode Secures cable clasp to patients clothing

*Apply electrode pads, pressing firmly to ensure contact.

Selects or changes desired lead and ECG size on monitor screen *

Highlights and selects by rotating SELECTOR and pressing.
Selects Lead by pressing LEAD button or by rotating SELECTOR to desired lead and
pressing
Selects Size by pressing SIZE button or by rotating SELECTOR to desired size and pressing

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Adjusts ECG size

Presses SIZE button repeatedly until desired size is displayed OR
Highlights and selects channel and then size, rotating SELECTOR to desired size
11 Alarm*
Set ECG monitor alarm limits as indicated, typically at 20 bpm higher and lower than the
baseline rate. Turn alarms on, and leave on at all times. Assess immediately if an alarm is
.triggered
1 .Remove and apply new pads every 24 to 48 hours and as needed *
.Clean gel residue from previous site, and document skin condition
2
.Use a different site if skin appears irritated or blistered *
.Time and date pads with every change *
1 .Save ECG strips according to policy, and when the rhythm or the clients condition changes *
.Note date, time, client, and monitor lead on each strip
3

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.Notify if significant changes in heart rhythm

*DOCUMENTATION
time and date Placed on cardiac monitor,
Initial
lead Monitor shows
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CARIAC MONITORINING
Note: candidate must complete all critical criteria . Critical action listed
above all as *

AL-Ghad International Colleges for Health Sciences

Academic and Educational Affairs
Emergency Medical Program

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Scene safety
BSi & Provide privacy
Explain the procedure to the patient. Identifies patient, , ensures
written consent has been obtained if not emergency situation
.Identifies the indications for synchronized cardio version
*Establish IV access with a sodium chloride 0.9% running line .
Obtains baseline VS and rhythm strip, to include EKG if time allows.
Prepare airway ,suction and ventilation equipment .
Consider sedation as per sedation protocol or policy .
*Position the electrodes and pads as appropriate
Confirms the dysrhythmia
*Ensure that synchronizer is on .
*Confirm the synchronization is occurring on the R wave .change the
ECG amplitude on the monitor if necessary.
Ensure the patient is well oxygenated / ventilated prior to and after *
.sedation and cardio version
ENERGY SELECT" to choose the energy to be delivered. (monitor "
specific)
Perform a maximum of three attempted synchronized cardio *
versions in accordance with following joule sequence : 50, 100, 150
.joules or as per protocol
Turns on ECG recorder

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*State, stand clear, charging pads*

Charge the defibrillator and wait for completion.
*Press and hold the shock button until the synchronized shock
deliver.
*Assess the following each cardio version attempt .

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*Record the procedure or on cardiac arrest flow sheet

Verbalizes need to obtain 12-lead ECG after cardio version, to
monitor patient for complications and provide continued patient
education.
Total

Note: candidate must complete all critical criteria . Critical action listed
above all as *

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Action
Scene safety
BSI
Positions the patient
Identifies indications for transcutaneous pacing.
Considers O2, IV, VS, rhythm strip with EKG if time allows.
If necessary, clip the hair over the areas of electrode placement. Do not

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shave the area.

Prepare the device for pacing ,attach the pad with cable . naked chest
area .
*Attach cardiac monitoring electrodes to the patient in the lead I, II, and III
positions. Do this even if the patient is already on telemetry monitoring. If
you select the lead II
Position, adjust the LL (left leg) electrode placement to accommodate the
anterior pacing electrode and the patients anatomy.
*Attach the patient monitoring electrodes to the ECG cable and into the
ECG input connection on the front of the pacing generator. Set the selector
switch to the Monitor on position.
Note the ECG waveform on the monitor. Adjust the R-wave beeper volume
to a suitable level and activate the alarm by pressing the Alarm on
button. Set the alarm for 10 to 20 beats lower and 20 to 30 beats higher
than the intrinsic rate.
*Press the Start/Stop button for a printout of the waveform.
*Apply the two pacing electrodes. Make sure the patients skin is clean
and dry to ensure good skin contact.
*Apply the anterior pacing electrode (marked Front),

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*Prepare to pace the heart. After making sure the energy output in
milliamperes (mA) is on 0, connect the electrode cable to the monitor
output cable.
*Gradually increase delivered current until capture is achieved (observes
pacer spikes
followed by wide QRS complexes at tall T waves)
*Check the waveform, looking for a tall QRS complex in lead II.

1.5

*Check the selector switch to Pacer on. Select synchronous or

asynchronous mode as per order ( Tell the patient "he or she may feel a
thumping or twitching sensation.)
*Set the pacing rate, Look for pacer artifact or spikes,

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*Secure the pacing leads and cable to the patients body.

Monitor the patients heart rate and rhythm to assess ventricular response
to pacing.
Assess the patients vital signs, skin color, level of consciousness, and
peripheral pulses.
Take blood pressure in both arms.
*Document
all important
steps . Colleges for Health Sciences
AL-Ghad
International

Academic and Educational

Affairs
Total
Emergency Medical Program

TRANSCUTANEOUS PACING
Note: candidate must complete all critical criteria. Critical action listed
above all as *

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Note: candidate must complete all critical criteria. Critical action listed
above all as *

AL-Ghad International Colleges for Health Sciences

Academic and Educational Affairs
Emergency Medical Program

Immediate Neonatal Care

1 BSI*
2 After delivery hold the baby and suctioning from mouth and then *
nose
3 Check baby is crying well *
4 Dry and stimulate the baby**
5 .Assess the babys breathing while drying *
6 Make sure there is not a second baby
7 .CHANGE GLOVES*
8 Put the baby on the between mothers beast on a clean, dry, *
.warm cloth
9 Quickly dry the baby from head to toe except for the hands. The
smell of the amniotic fluid on the babys hands also smells much
like the mothers nipple/areola area. When the baby crawls up the
abdomen of the mother the smell on the hands help the baby to
.find the breast
1 Check Apgar score, after 1 mint of delivery and 5 mints **
0
11 . Remove the wet cloth, and cover with dry cloth *
1 Do delayed cord clamping 2-3 m, and Check baby often for *
2 .breathing and color
1 Clamp now, Put one artery forceps or plastic cord clamp about 4 *
3 .fingers from the babys abdomen
1 Gently milk the cord towards the placenta
4
1 Put a second clamp on the cord approximately 2 fingers from the *
5 .first clamp
. Cover cord with gauze and cut
1 Clean the eyes of baby with wet cloth and put drops as per *
6 protocol
1 . Weigh the baby. Give inject vit K *
7
1 Maintain the temperature by thermostat **
8
1 .Leave baby on mothers chest in skin to skin contact
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2 .Place identification labels on baby arm and leg *
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2 . Print a foot on white page for identification purpose *

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2 .Cover mother and baby with blanket *
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2 Document every thing*
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2 Transport if necessary
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2 .If baby is not breathing, begin resuscitation while drying **
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Total

Note: candidate must complete all critical criteria. Critical action listed
above all as *

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