12leadsmadeeasy-091215141959-phpapp02
TRANSCRIPT
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12 Leads Made EasySTEMI Recognition Class
Michael D. Murley
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12 Leads Made Easy
Module 1 – Introduction to 12 Leads
Module 2 – Learn to Identify the J Point
Module 3 – Learn to identify ST Elevation
Module 4 – Lead Views
Module 5 – Game for review
Module 6 – Putting it all together, STEMI Recognition
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Module 1 Intro to 12 Lead
Most 12 Leads have this common layout
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Module 1 Intro to 12 Lead
4 Columns
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Module 1 Intro to 12 Lead
3 Rows
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Module 1 Intro to 12 Lead
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Module 1 Intro to 12 Lead
Practice filling in the Leads
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Module 1 Intro to 12 Lead
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Module 2 Learn to ID the J Point
STEMI
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Module 2 Learn to ID the J Point
Achieved by obtaining a rapid 12 Lead ECG
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Module 2 Learn to ID the J Point
While it is possible to identify Myocardial Infarction by clinical presentation,
Lead II = No Clue
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Module 2 Learn to ID the J Point
We will learn how to:
• Locate the ST Segment
• Identify which parts of the ST Segment we use for analysis
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
Junction Point or J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
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Module 2 Learn to ID the J Point
Now that you know how to find the J Point, let’s learn how to find J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
Don’t compare J Point to the PRI segment, there are medical conditions that my cause PRI depression
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Module 3 Learn to ID J Point elevation
Your eye wants to compare it to the PRI, but that’s not best reference point
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Module 3 Learn to ID J Point elevation
The TP segment provides the best baseline to evaluate ST elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
Let’s practice finding the J Point and check for elevation/depression
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Module 3 Learn to ID J Point elevation
Let’s practice finding the J Point and check for elevation/depression
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Learn to ID J Point elevation
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Module 3 Review
We’re half way there. In order to recognize STEMI you have to know 2 things
• What to look for (ST elevation)
• Where you are looking (which Lead)
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Module 4 Lead Views
In Module 4 we will learn which part of the heart that each lead sees.
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Module 4 Lead Views
There are many different leads with many different features
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
The heart is not oriented vertically in the chest
Left Ventricle is Cone shaped and it rest on the diaphragm
Left Ventricle is divided into 5 regions
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
• Posterior
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Module 4 Lead Views
The QRS complexes are created primarily by the electrical activity occurring in the Left ventricle
Q
R
S
You can think of each Lead as seeing a different portion of the Left ventricle
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
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Module 4 Lead Views
The criteria for a STEMI is ST segment elevation in two or more contiguous Leads
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Module 4 Lead Views
Only for ventricular Leads
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Module 4 Lead Views
V1 V2
V3
V4 V5 V6
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 5 Review
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Module 6 STEMI Recognition
Now we know what we are looking for (ST elevation) and where we are looking (Lead views)
It’s time to put it all together by taking a step by step approach to reading 12 Lead ECG’s
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Module 6 STEMI Recognition
Interrupting the 12 Lead requires you to go Lead by Lead, selecting one good representative complex
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Module 6 STEMI Recognition
Pick one with a good baseline to compare and DON’T select a PVC or any ectopic complex for analysis
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Module 6 STEMI Recognition
Pick one with a good baseline to compare and DON’T select a PVC or any ectopic complex for analysis
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Module 6 STEMI Recognition
Once you have your complex, find the J Point and determine if ST elevation is present
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Module 6 STEMI Recognition
Check each Lead, one by one, throughout all the Leads except aVR. When you’re down, answer this question
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Module 6 STEMI Recognition
If so, suspect STEMI
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Module 6 STEMI Recognition
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Module 6 STEMI Recognition
Let’s practice
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Module 6 STEMI Recognition
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Module 6 STEMI Recognition
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Module 6 STEMI Recognition
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Module 6 STEMI Recognition
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Module 6 STEMI Recognition
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Congrats! Let’s practice!
Let’s Practice
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Practice 12 Leads
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Practice 12 Leads
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Practice 12 Leads
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Practice 12 Leads
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Practice 12 Leads
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Practice 12 Leads
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FIN