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Technique matters To ensure accurate lead monitoring, you must apply the electrodes correctly. Follow these steps for accurate lead placement: • Clip dense hair at each site. • Prepare the skin by briskly rubbing each site until the skin reddens using the rough patch on the back of the electrode or a dry gauze pad. Peak technique Using a five-leadwire system This illustration shows the correct placement of leadwires for a five-leadwire system. The chest electrode shown is located in the V1 position, but you can place it in any of the chest lead positions.
12 second); otherwise, the PR interval can’t be measured. • QRS complex: Duration within normal limits; usually normal configuration. indd 37 10/7/2011 4:17:59 PM RECOGNIZING CARDIAC ARRHYTHMIAS 38 • T wave: Usually normal configuration but may be abnormal if the P wave is hidden in the T wave. Fast rate may make the T wave indiscernible. • QT interval: Usually within normal limits. What do you mean "junctional tachycardia"? I feel fine. What causes it • • • • • • • • Digoxin toxicity (most common cause) Cardiomyopathy Enhanced automaticity Hypoxia Inferior wall MI and ischemia Myocarditis Vagal stimulation Valve replacement surgery What to look for • Pulse rate greater than 100 beats/minute • Usually no symptoms if the patient can compensate • Possibly signs and symptoms of decreased cardiac output if compensation is poor How it’s treated • Discontinue digoxin therapy.
Torsades may be paroxysmal, starting and stopping suddenly. Although sinus rhythm sometimes resumes spontaneously, torsades de pointes usually degenerates into ventricular fibrillation. indd 44 Torsades de pointes may start and stop suddenly. 10/7/2011 4:18:03 PM RECOGNIZING WIDE COMPLEX TACHYCARDIAS 45 What the ECG tells you • Rhythm: Atrial rhythm can’t be determined. Ventricular rhythm is regular or irregular. • Rate: Atrial rate can’t be determined. Ventricular rate is 150 to 250 beats/minute.
ACLS Review Made Incredibly Easy by Lippincott Williams & Wilkins