Conduct An Ekg Examination

CONDUCT AN EKG EXAMINATION ELECTROCARDIOGRAPHIC EXAMINATION A. Heart Physiology 1. Cardiac Conduction System In general, the heart is formed by three types of excitatory cells: - Pacemaker cells as a source of cardiac bioelectricity - Conducting cells as conductors of cardiac bioelectric currents - Heart muscle cells (myocardium) which function for contraction Electrical communication in cardiac the heartconduction begins withsystem actionand potentials in autorhythmic cells. Heart beats originate from a special spread to all parts of the heart muscle through this system. The structures that make up the cardiac conduction system are the sinoatrial node (SAsystem. node),Under the atrioventricular node (AVthe node), the bundle of Hispacemaker. and its branches, and the Purkinje normal circumstances SA node is the main 2. Cardiac Cycle The process of regular depolarization ofcontraction the heart triggers aright contraction that spreads The through the myocardium. In each muscle fiber, begins after depolarization. heart contracts and relaxes during cardiacdocycle. Each cardiac cycle athasthetwosame phases, diastolic and systolic. The atria andone ventricles not contract and relax time.namely 3. Electrical Events in the Cardiac Cycle Afterelectrical we discuss heartin electricity and the cardiac cycle, we will then discuss electrical events, inthethis case waves electrocardiography are associated with contraction or relaxation of heart muscle in general. The mechanical events in the cardiac cycle lag slightly behind the heart's electrical signals (contraction ofcardiac the heart muscle following anatria action potential). This isrest. the reason why many leads are used. The cycle begins when the and ventricles are at Meanwhile, ECG begins with(waves) atrial depolarization. following image explains relationship between ECGtheelectrical events during a cycle ofThecontraction-relaxation of thetheheart muscle: B. ECG examination Understanding Annode ECG examination is an actthrough of recording the heart'ssystem electrical activity starting from the sinoatrial which is conducted the conduction fiber network in the heart causes the heart to contract which can be recorded via electrodes placed/attached to the skin.which a. Preparation b. Probandus/patient preparation: c. It is best to rest 15 minutes before the examination. d. If using jewelry/metal, remove it e. The patient is asked to undress the chest f. The patient is asked to sleep on his back, the examiner's position is on the patient's left g. The patient is tried to be calm, breathe normally, and during the recording process he is not allowed to talk h. Clean the area where the electrode will be installed with alcohol cotton i. Apply ECG paste to thebeforehand electrodes to improve electrical conductivity.It's best not to smoke/eat 30 minutes To read/interpret an ECG, we must at least have data about the following things: a. Age because the shape of a normal ECG in babies and children is very different fromofa sufferer: normal ECG in adults. b. Height, weight and body shape: obese people have a thick chest wall, sotothetheamplitude oftheall ECG complexes is smaller, because the voltage is inversely proportional square of electrode distance to the heart muscle cells. c. Blood pressure andventricular general condition ofis related the patient: It possibility is importantof whether the increase in voltage in the left complex to the left ventricular hypertrophy and dilatation. d. Lung disease inbysufferers: the position the heart and the voltagepleural of the effusion ECG complexes can be influenced the presence of severeofpulmonary emphysema, and others. e. Use of digitalis medication andresult its derivatives: will greatly affect digitalis the shapeneeds of thetoECG. So, for example, if you need an ECG that is free from side effects, be stopped for at least 3 weeks from the digitalis drug. 2. Lead (Lead) Ifconnections electrocardiography connected to two pointsthatonare theoften body,used theninthe specific is called aislead. The types of leads EKGs are: image of each pair of a. Bipolar Extremity Lead: Einthoven, thethrough father oftheEKG, in 1913 explained that the heart dipole could beequilateral depicted intriangle, a frontal plane passing heart, and as if it were located in the center of an where the two cornersplaced are at the samewrist height atankle the top andthus the apex is atthree the bottom. Einthoven used three electrodes on the and (limb), forming bipolar limb leads to record potential differences in the heart's bioelectric current. The polarity orientation of the bipolar limb lead axes is as follows: a. Lead I: wherepoll theisnegative polltofrom electrocardiography is connected to the right wrist and the positive connected the left wrist. b. Lead II: wherepolltheisnegative electrocardiography is connected to the right wrist and the positive connectedpolltofrom the left ankle. c. Lead ankle.III: where the negative poll is connected to the left wrist and the positive poll to the left d. Using these three leads will form an equilateral triangle with the conducting heart positioned in the middle. It has been explained previously that the body is a good volume. So lead Ipropagate actually measures the potential difference of all the heart's bioelectric currents that horizontally.currents Likewise, leads IIaand IIIangle will each measure the potential difference of all cardiac bioelectric that form 60° from the upper left quadrant to the lower right, and from the upper right quadrant to the lower left. b. Unipolar Extremity Lead: Inresistance this recording, 2 members are connected toconnected the electrocardiographic negative resistance electrical terminal terminal, while the 3rd member is to the positive electrical so that there are 3 types of leads: aVR = when the positive terminal is connected to the right arm aVL = when the positive terminal is connected to the left arm aVF = when the positive terminal is connected to the left leg c. Precordial Lead An EKG examination also requires placing a lead on the frontand chest wall aboveelectrode the heart.orThis lead is connected to the positive terminal on electrocardiography, the negative also called indifference is usuallyelectrode connected via electrical the right(0). arm, left arm and left leg together.electrode This indifference is made to alwaysresistance have zerotopotential Installation of leads with only one active electrode is called a unipolar lead. There are 6 types of precordial leads, namely: a. V1 = positive electrode in the right lateral sternal line (sic) IV intercostal space b. V2 = positive electrode on sic IV lateral to the right sternal line c. V3 = between V2 and V4 d. V4 = positive electrode at sic V on the left medio clavicular line e. V5 = positive electrode at sic V in the left anterior axillary line f. V6 = positive electrode at sic V in the left medial axillary line 23 ECG Installation and Recording After the patient and ECG machine are prepared, the following steps are carried out: a. Install the electrodes according to their respective leads b. Bipolar and unipolar limb leads c. Leads I, II and III are placed on the right and left wrists and right and left ankles d. ABlack red electrode iswere attached to thetoright wrist.ankle. A yellow electrode is attached to thetoleft wrist. electrodes attached the right A green electrode is attached the left ankle Precordial lead 1) Place lead V1 in the IV intercostal space lateral to the right sternal line 2) Place lead V2 in the IV intercostal space lateral to the left sternal line 3) Install lead V3 between V2 and V4 4) Place lead V4 in the V intercostal space at the left medio clavicular line 5) Place lead V5 in the V intercostal space in the left anterior axillary line 6) Place lead V6 in the V intercostal space in the left middle axillary line a. Enter the ID number: point the cursor to the ID text then press enter then press ↑ or ↓ b. Enter age: point the cursor at age then press enter then press ↑ or ↓ ELECTROCARDIOGRAM EXAMINATION a. Pre-Interaction Stage b. Assess patient needs according to related actions c. Tools are fully prepared d. The device is brought closer to the patient e. Wash your hands properly Orientation Stage a. Offer greetings as a therapeutic approach b. Give the nurse's name again c. Make sure the identity of the client whose action will be taken is correct d. Explain the objectives and procedures of action to the client/family e. Ask the client's readiness before the activity is carried out f. Adjust the client's position until the client feels comfortable g. Close doors/windows/put up curtains, make sure there is sufficient light in the room Work Phase a. Prepare and bring the equipment closer to the patient b. Loosen or remove the client's upper clothing. c. Apply jelly to the electorde Place electrodes on the upper and lower extremities to record the extremity leads: a. Red on right upper extremity b. Yellowness in upper left extremity c. Black on lower right extremity d. Green on lower left extremity Attach paracardial electrodes to record precardial leads: a. Place V1 at the 4th intercostal line of the right sternum b. Place V2 at the 4th intercostal line of the left sternum c. Place V3 in the middle of V2 and V4 d. Place V4 at the 5th intercostal at the left midclavicle e. Place V5 on the anterior axillary line f. Place V6 in the mid-axilla parallel to V4 g. Turn on the Electrocardiogram machine h. Record the client's identity on the ECG i. Perform calibration at a speed of ml/sec j. Perform recording according to order k. Turn off the ECG and remove the electrodes on the client's body l. Help the client put clothes back on. TERMINATION STAGE a. Evaluate responses and actions carried out correctly b. The patient is well groomed c. Provide education related to follow-up after the action is taken d. Tools are neatly arranged e. The subsequent time contract was submitted correctly f. Therapeutic greetings are delivered in a friendly manner g. Wash your hands properly