chapter 1 role of the electrocardiographer. the number one cause of death in the united states is...

Chapter 1

Role of the Electrocardiographer

Electrocardiographyfor Healthcare Personnel

The number one cause of death in the United States is cardiovascular disease

500,000 deaths every year due to coronary artery disease

More than one in five Americans suffer form heart disease

ECG/EKG – Electrocardiogram – diagnostic tool giving information r/t: heart disease, abnormalities, rate, rhythm, electrical activity of the heart


Reasons to perform EKG’s1. Determination of pumping/contraction2. Check flow of electricity thru the heart3. Diagnose changes in heart rhythm4. Check for abnormalities before surgery5. Physical exam after age 40/Health Evaluation6. Monitor/evaluate individuals with heart conditions

An inaccurate tracing could result in a wrong decision about medication or treatment which could result in a negative outcome for the patient


Major Risk factors for Heart DiseaseFactors that are unchangeable1. Increasing age: 4 of 5 who die > 652. Older women 2x more likely to die than men3. Gender: Men > risk earlier, after

menopause, death rate for women increases4. Heredity (including race) Children of

parents with heart disease more likely to develop CAD / African Americans > hypertension > risk


Factors that can be changed:1. Cigarette and tobacco smoke 2x > risk2. High Blood Cholesterol levels3. High Blood Pressure – coexisting obesity,

cholesterol, smoking = several times the risk4. Physical Inactivity5. Obesity / Overweight – even without other

factors6. Diabetes7. Stress – may lead to overeating, smoking,

increased smoking


History of the EKG1676 – Discovery animals generate electricity1887 – Dr. Augusta D. Waller – credited with

first EKG on a humanEinthoven – First practical galvanometer, in

1903, invented the first EKG / Nobel Prize 1924

Dr. James B. Herrick – 1918 abnormal tracing and symptoms could indicate MI, heart attack

Today: nurses, physicians, medical assistants,RT’s, radiology personnel, PCT’s perform EKG’s


Wilhelm Einthoven1867-1927

The ECG Technician is an individual who records the EKG and prepares the report for the physician and should be able to:

1. Determine if the tracing is accurate2. Recognize abnormalities caused by interference3. Report abnormalities to the nurse or physician4. Maintain patient rec ordsMost EKG Technicians are:5. Employed in hospitalsEKG Technicians may work in:6. Medical offices7. Cardiac rehab centers8. Home health care9. Telemetry Centers (monitor Tech)


EKG Techs may wish to advance their training and become a CARDIOVASCULAR TECHNOLOGIST

Assist physicians with invasive cardiovascular diagnostic tests such as:

1. Angioplasty2. Heart surgery3. Implantation of artificial pacemakers4. Ultrasound of blood vessels5. Also perform EKG’s


How ECG’s are used:Looking for changes from a normal tracing,

or the first EKG tracing done (baseline comparison)

As part of an annual physical for patient’s over 40

Used in a number of healthcare settings such as – acute care (ICU, ER), EMS, Transmitted over a telephone from home, clinics, etc.


In the Hospital (Acute Care)12 Lead EKG, most common in hospitalsMay be routine, or Code Blue (cardiac arrest)Emergency (STAT) immediately – patient may be having

chest pain, or a change in rhythmRoutine are done usually early morning so MD can see

on morning rounds, also pre-op EKG’s are routineContinuous monitoring – ICU, CCU, SINU, ER, Recovery,

OR, may get O2 sats. and vital signsAn inaccurate tracing may result in: misdiagnosis,

medication errors, serious adverse outcomes REMAIN calm during STAT EKG’s, avoids

stress/confusion


TELEMETRY – a type of continuous monitoring

Monitor usually in a small case with electrodes attached to the patient’s chest

Can usually ambulateTracings are transmitted to a central location

for monitoring and evaluation (telemetry station)


Conditions Evaluated by the EKG 1. Disorders in heart rate, rhythm, or conduction 2. Electrolyte imbalance 3. Condition of heart prior to defibrillation 4. Damages assessment during/post MI 5. Structural heart or coronary blood flow disorder 6. Evaluation of CP, SOB, weakness 7. Dx of certain drug toxicities (digitalis) 8. Dx metabolic disorders: K+, CA++, acidosis (pH),

hypothyroidism 9. Pre-operative eval in asymptomatics or at risk pt. 10. Damage assessment pot chest, head, spinal c. trauma 11. Assessment of cardiotoxic / antiarrhythmic drugs 12. Suspicion of congenital heart disease 13. Pacemaker function


Treadmill Testing – AKA Exercise Electrocardiography

Determines whether the heart is receiving adequate blood during stress or exercise

A physician should always be presentSafe, inexpensive, reliable___________________________________________Holter Monitor – small box and electrodes –

24-48 hours during patient’s normal daily activity


DefibrillationIf an abnormal pattern requires immediate

treatment, cardiac medications are administered, or a defibrillator is used

A defibrillator produces an electrical shock intended to correct the hearts electrical pattern (AED or Lifepack) AED Layperson, Lifepack – emergency personnel

Transtelephonic monitoring: Used up to 30 days – Smallest available: size and shape of a beeper with 2 electrodes – one type is applied as symptoms occur – left arm wristwatch or credit card type


What do you need to know to perform and EKG?

ProcedureEKG machineAbility to lift and move patientTransport and operate the EKG machineUnderstand principles of safety / infection

control / patient education / communication / law / ethics

Ability to troubleshoot procedural problems


UNIVERSAL PRECAUTIONSGuidelines to prevent the spread of infectionEssential to prevent the spread of infectionBased on recommendations by the CDCMandated by OSHAUsed for all patients with or without infections____________________________________________STANDARD PRECAUTIONSPracticed on patients with known or suspected

infectionsCombination of Universal Prec. and BSI


BODY SUBSTANCE ISOLATIONRecommended by the CDCReduces the risk of disease transmission of

pathogens from moist body substancesStandard Precautions apply to… blood, all body

fluids, secretions, and excretions except sweat regardless of whether or not they contain visible blood, nonintact skin, mucous membranes

SP require use of barriers: PPE, gloves, gowns, masks, eye protection: SP’s apply to isolated patients with known or suspected infections


UP Hand WashingAfter touching blood, bodyfluids, secretions, excretions, Contaminated itemsBefore putting on glovesAfter removing glovesBetween patient contactsBetween tasks and procedures on the same patient


UP Gloves: Wear gloves when: touching blood, body fluids, secretions, excretions, and contaminated items

Touching mucous membranes and nonintact skin

Change gloves: Between procedures and patients, after contacting materials that are highly contaminated

Remove gloves: Promptly after use, before touching

uncontaminated surfaces and items,WASH YOUR HANDS IMMEDIATELY AFTER GLOVE REMOVAL


Masks, Eye Protection, Face ShieldsProtects mucous membranes of themouth, eyes and nose from splashesand sprays


Wear mask, eye protection, and face shields during procedures and tasks likely to cause splashes, sprays of blood, body fluids, secretions and excretions

GOWNSProtect the skin and clothingWear expecting sprays,

splashes, blood, body fluidsRemove promptlyWash hands STAT after

gown removal


EQUIPMENTMay be soiled / blood, body fluids, secretions, excr.Reusable equip. must be cleaned, disinfected, or

sterilized before use on another patient.Discard single-use equipment promptly

ENVIRONMENTAL CONTROLFollow facility procedures r/t surfaces, equip., etc

OCCUPATIONAL HEALTH and BBPUse resuscitation devices for mouth to mouth / CPR


HANDWASHINGThe single most important procedure you can

perform to prevent the spread of infection. When practicing Universal Precautions and wearing gloves, you must wash your hands before putting gloves on and after removing them to prevent disease transmission


Patient Education and CommunicationKey to success in recording and EKGA positive relationship and environment reduces

apprehension, anxiety and fearClearly explain the procedureAnswer questionsFriendly, confident mannerCooperation increase if pt. trusts you are

competentUse simple terms, speak slowly and distinctlyRepeat the instructions as needed


HARD OF HEARING !!!!! Look directly at the patient Speak slowly Speak distinctly May be able to read your lips

____________________________________________________________

LANGUAGE other than English

Interpreter or family member


LEGAL and ETHICAL ISSUESLaws are rules of conduct enforced by a

controlling authority such as the governmentUnlawful act consequences: job loss, fine, jailEthics are concerned with standards of

behavior and concepts of right and wrongEthics are based upon moral values formed

thru the influence of family, culture, societyIllegal acts are always unethical, unethical

cats are not always illegal


PRACTICING ETHICSStandards of behavior or conduct defined by a

professional groupConfidentiality (HIPPA) – a breach in confidentiality is

both illegal and unethicalTreat patients with respect and dignityRespect privacy at all timesAvoid physical exposure – close door, drape, pull curtainRespect beliefs, values, and moralsContinue to learn and provide professional careWork cooperatively with co-workers and supervisors at

all times


Legal Issues:Healthcare Professionals are legally responsible for

for his or her performanceAssumes accountability for1. performing unlawful acts2. performing legal acts improperly3. failing to perform an act when they should_____________________________________________Never speak defamatory words about a patientDerogatory remarks which jeopardize a reputation or means of livelihood is called slanderWriting defamatory words is called libel


REQUIRED Entries for the Medical RecordPt. I.D., Full Name, SSN, birth date, full address, telephone

number, marital status, place of employmentMedical HistoryDates/Times all appointments, admissions, discharges, and

diagnostic tests such as an EKGDiagnostic Test Results (labs)S/S, reason for appointmentPhysician exam notes, findings, patient instructionsMedications, prescriptions given, refillsAll informed consents and for specific procedures and

treatmentsLegal Guardians, representatives as needed for consent


BREACH of CONFIDENTIALITY

The patient’s chart should not be left out or open in an area where other patient’s or visitors may be able to view it. This is a breach of confidentiality


“You never know who might read your particulars and what-not”

Maxwell the Pig 2014

chapter 1 role of the electrocardiographer. the number one cause of death in the united states is...

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