Electrocardiogram

(ECG)

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 Out line
 anatomical structure and function of conductive
system
 identified the normal ECG

 calculation of ECG wave in ECG paper

 calculation HR in ECG paper

 calculation ECG axis

 ECG equipments

 identify ECG lead and its places in the patient body

 types of arrhythmia

 References
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 Definition

It is a record of electrical
potential that generated by the
heart during cardiac cycle (systole
and diastole).

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 The electrical impulses
spread from the heart to
the surrounding tissue
the toward outer surface
of the body where the
ECG electrodes are
placed.

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 Normal ECG wave

Duration amplitude Atrial depolarization 0.02 s P

0.1s 0.1-0.3 mv Atrial systole wave

0.04-0.12s 1-2 mv (V) depolarization 0.02 V Systole QRS

0.25 s 0.2-0.3mv ( V ) Repolarization T

0.12-0.2s Time P till R P-R

0.1s Iso line S-T

0.3-0.4s (V) R&D Q-T

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 ECG paper
 Ventricle 1cm=1mv =10 small box(1 box=0.1mv)
 Horizontal 1 small square=0.04 second
5 big square= 0ne second

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ECG paper

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 ECG equipments
 ECG machine & ECG leads
 ECG paper

 alcohol swap

 ECG jell

 gloves

 tissue

 Shaving machine

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 Nursing care
 explain the procedure to the patient
 prepare equipments

 wash hands

 clean leads area by alcohol swap (shave if need)

 apply ECG jell on ECG leads

 attach ECG leads on the patient body

 make sure all leads are on

 turn on ECG machine

 print result into ECG paper

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 ECG leads
Get complete picture of activities of the heart.
It is 12 leads placed on the surface of the body
according the following:
12 leads

6 limb leads 6 chest leads

1- bipolar leads (I,II,III) V1,V2

,V3,V4,V5,V6
2-unipolar leads (avR,avL,avF)

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 bipolar leads
 Have two electrodes (positive and negative)
 It is placed on R arm, L arm, L leg .
 There is one extra electrode placed on R leg
called grounded electrode

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 bipolar leads
Negative terminal Positive leads
terminal
Right arm Left arm I

Right arm Left leg II

Left arm Left leg III

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 Unipolar leads
 One active electrode connecting to the positive terminal
in ECG
 avR (present in R arm)
 avL (in L arm)
 avF (in L leg)

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Chest leads

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 Chest leade
 V1- present in right fourth intercostals space near sternum
 V2- present in left fourth intercostals space near sternum
 V3- present between V2 and V4
 V4- present in fifth intercostals space in mid line of clavicle
 V5- present in fifth intercostals space in anterior part of
axilla
 V6- present in fifth intercostals space in mid line of axilla

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 References
1 Suzanne C. Smeltzer, Brenda G Bare,
Janice L. Hinkle, Kerry H Cheever ,
Brunner and Suddarth's textbook of
medical-surgical nursing, ( 12th edition ).
2009, page (720-740)

2- Dale Davis, ECG interpretation, second

edition , 1992.
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