41: Assisting With Cardiac Monitoring

Objectives (1 of 2)

1. To gain an understanding of basic terminology

and techniques of cardiac monitoring.
2. To give you the knowledge and tools you need to
assist the advanced provider with the use and
implementation of an ECG.
3. To better understand the basic anatomy and
physiology of the heart.
 Objectives (2 of 2)
1. Identify the components of basic cardiac
arrhythmias.
2. Evaluate the rate and rhythm of a patient’s
cardiovascular system, and become familiar with
the normal ECG.
3. Familiarize yourself with and apply 4-lead
electrodes and identify placements for the 12-lead
systems.

*All of the objectives in this chapter are noncurriculum

objectives.
 Cardiac Monitoring
• Use of 12-lead ECGs in the prehospital setting is
becoming the norm.
• Early identification of AMIs allows hospitals to be
prepared.
• The EMT-B should know how to place electrodes
and leads.
Electrical Conduction System (1 of 2)
• A network of specialized tissue in the heart
• Conducts electrical current throughout the heart
• The flow of electrical current causes contractions
that produce pumping of blood.
Electrical Conduction System (2 of 2)
 The Process of
Electrical Conduction
• Electrical conduction occurs through a pathway of
special cells.
• SA node: the heart’s main pacemaker
– Paces at a rate of 60–100 beats/min
– Average of 70 beats/min
 Electrodes and Waves

Electrodes pick up electrical activity of the heart.

 The ECG Complex
• One complex represents one beat in the heart.
• Complex consists of P, QRS, and T waves.
 ECG Paper
• Each small box on the
paper represents 0.04
seconds.
• Five small boxes in
larger box represents
0.20 seconds.
• Five large boxes equal
1 second.
Normal Sinus Rhythm
• Consistent P waves
• Consistent P-R interval
• 60–100 beats/min
Formation of the ECG (1 of 4)
Formation of the ECG (2 of 4)
Formation of the ECG (3 of 4)
Formation of the ECG (4 of 4)
Sinus Bradycardia
• Consistent P waves
• Consistent P-R interval
• Less than 60 beats/min
Sinus Tachycardia
• Consistent P waves
• Consistent P-R interval
• More than 100 beats/min
 Ventricular Tachycardia
• Three or more ventricular complexes
in a row
• More than 100 beats/min
 Ventricular Fibrillation
• Rapid, completely disorganized rhythm
• Deadly arrhythmia that requires immediate
treatment
 Asystole
• Complete absence of electrical cardiac activity
• Patient is clinically dead.
• Decision to terminate resuscitation efforts depends
on local protocol.
 Cardiac Monitors
• May be 3-, 4-, or 12-lead system
• Compact, light, portable
• Many monitors now combine functions beyond
ECG.
 12-Lead ECG
• Used to identify possible myocardial ischemia
• Studies show 12-lead acquisition takes little extra
time.
• Early identification of acute ischemia and accurate
identification of arrhythmias
 Lead Placement
• EMT-Bs can help in efficient cardiac monitoring by
placing electrodes.
• Electrodes can be placed while ALS provider
prepares other parts of call.
 4-Lead Placement
• Four leads are called
limb leads.
• Leads must be placed
at least 10 cm from
heart.
 12-Lead Placement
• Limbs leads placed at
least 10 cm from heart.
• Chest leads must be
placed exactly.

Lead Location View

V1 4th intercostal space, right sternal border Ventricular septum

V2 4th intercostal space, left sternal border Ventricular septum

V3 Between V2 and V4 Anterior wall of left ventricle
V4 5th intercostal space, midclavicular line Anterior wall of left ventricle
V5 Lateral to V4 at anterior axillary line Lateral wall of left ventricle
V6 Lateral to V5 at midaxillary line Lateral wall of left ventricle
Troubleshooting
• Clean skin.
• Use benzoin.
• Shave hair.