Optional or Required, EMT & AEMT

EKG 12-lead Data Acquisition

Course Objectives
1) Define purpose of 12-lead
2) Know the indications for 12-lead
3) Describe the procedure for application
4) Describe the procedure for obtaining 12-lead
information
5) Understand complications of 12-lead
6) Understand transmission of 12-lead data
7) Know how to document 12-lead data
Purpose of EKG
Electro Cardio Gram (ECG or EKG) allows us to
see the electrical activity of the heart
Trained professionals are able to interpret rhythm
EKGs allow for determining possible:
Heart arrhythmias
Sites of heart attacks
Heart abnormalities
Indications for 12-lead
Chest pain, or any anginal symptoms
Respiratory problems
Overdose
Stroke
Heart arrhythmias
Resuscitation
There are no contraindications
So use when ever you may think it appropriate
Application of 12-lead
12-lead consists of 10 electrodes
Electrode placement is important
Electrodes view heart from different directions
12-lead shows 12 different leads
Leads I, II, III, aVr, aVl, aVf, and V1-V6
Placement locations
4 limb leads (RA, LA, RL, LL)
6 leads across chest (V1, V2, V3, V4, V5, V6)
Placement of electrodes
Avoid hair and thick muscle mass (trim hair if needed)
Cleanse site with alcohol to remove dirt and oil
Then attach
Limb Leads
Each limb has a
lead
Leads can also
be moved in to
shoulders and
abdomen
Electrodes should
be placed on
inside of limbs

Chest (precordial) leads
V1- 4
th
intercostal space on
right sternal border
V2- 4
th
intercostal space on
left sternal border
V3- Between V2 & V4
V4- 5
th
intercostal space @
midclavicular line
V5- level with V4 @ left
anterior axillary line
V6- level with V5 @
midaxillary line
Remember to respect
modesty as best as possible
Obtaining the 12-lead
Best to do before leaving, if practical
Once electrodes are on:
Turn monitor on
Push 12-lead button
Input information that it asks for (age)
12-lead will then start
Print 2 strips
One for ER upon your arrival
One for your documentation
Transmit 12-lead (if applicable to your service)
This is a normal
adult ECG
82 year old lady
with dizzy spells
Atrial fibrillation and
complete heart block
Complications
Patient movement can affect readings
Ask patient to hold as still as possible
Loose electrodes will either not show readings,
or alter them
Check electrodes
Moving ambulance affects readings
Do before leaving or when stopped
Loud noise
Do everything you can to minimize noise
Transmission
Purpose:
Saves time in ER for serious patients, they can get
to advanced care more quickly
Allows hospital to compare current ECG with
previous 12-leads of the patient while you are still
enroute
Physician can compare changes that occurred during
your transport
Best to do when patient is in pain, signs may not
be present on ECG during non-pain

Transmitting basics
Each monitor is slightly different in operation and
transmission options
In general:
Hospital needs to be set up to receive
transmission
12-leads can be sent to a computer, fax, PDA, etc.
Ambulance needs transmitting device (cell
phone, radio, Bluetooth, etc.)
Once all leads are placed, obtain 12-lead, then
transmit according to set up
Documenting Your 12-lead
12-lead data should be included in patient care
reports for every patient that receives one
Should include:
Copy of the 12-lead
Time 12-lead was obtained
Information about transmission (successful?)
If 12-lead was not obtained, but should have
been, document reason not obtained

Videos
The Videos below give a good general overview
of 12-leads.
Video on application
12 Lead ECG Placement Part I
http://www.youtube.com/watch?v=eA5HmQSMGHE

Video on trouble shooting
12 Lead ECG Placement Part II
http://www.youtube.com/watch?v=TFcyiCKyaZ4
Skill Overview
In the skills station you will be required to:
Do initial assessment
Establish patient is a candidate for 12-lead
Place electrodes properly
Acquire 12-lead and print 2 copies
Describe transmission and documentation
Transport patient
Summary
Purpose of the 12-lead is to see electrical
activity of heart and help diagnose heart
problems
Indications include: chest pain, overdoses,
strokes, respiratory problems, etc.
10 electrodes are placed on the body with 4
limb leads and 6 chest leads
12-lead is obtained by pushing the 12-lead
button on the monitor and inputting information
asked for
Summary cont.
Complications can include: movement, loose
electrodes, and noise
Transmission is done after obtaining the 12-lead
and uses a transmitting device and a receiving
device at the hospital
The 12-lead is documented with a copy of the
12-lead and the time it was obtained
Attach it to the patient care report