certified ekg technician certification
DESCRIPTION
Thomas Forti R.N. Certified EKG Technician Certification. The EXAM. Certified EKG Technician CET GED and 60 HRs of training 110 Questions (100 Scored) 110 minuets Web exam Score given following the exam Don ’ t spend too much time on one question - PowerPoint PPT PresentationTRANSCRIPT
CERTIFIED EKG TECHNICIAN
CERTIFICATION
Thomas Forti R.N.
The EXAM Certified EKG Technician
CET GED and 60 HRs of training 110 Questions (100 Scored)
110 minuets Web exam Score given following the exam Don’t spend too much time on one question Try and figure out the answers before
reading the answers Eliminate incorrect answer to try and figure
out correct answer
HIPAA The Health Insurance Portability and
Accountability Act of 1996 Patient has right to confidentiality Safeguards to ensure that an
individual's health information is used only for purposes related to treatment, payment, or healthcare operations
You are responsible for this when at work.
HIPAA Medicinal information needs to be sent
via secure (encrypted) pathways Best way is to personally deliver the
information (Handing the MD the EKG)Not leaving it in a mail box where someone
else could view it. Keep work area clear of patient
information when you walk away
Protected Health information Any information about
Health status Health care services Payment Patient identifiers Social security Hone numbers Address Treatment Assessment Test results Diagnoses Medications
During Direct contact Phone calls Faxes Emails
Anatomy and Physiology 4 Chambers of the Heart
Right and Left AtriaRight and Left Ventricle
Sepal wall separate right from left sides
Three layers of the heartEndocardiumMyocardiumEpicardium
Heart is in a sac calledPericardium AKA Pericardial SacProvided protection and lubrication
Anatomy and Physiology Four Valves of the heart
Tricuspid and Mitral○ Between the atria and
ventriclePulmonary and Aortic
○ Blood exits heartChordae Tendineae
○ Provide support to A-V valves to prevent regurgitation (incompetence)
Anatomy and Physiology Coronary Arteries
Vessels that supply blood to the myocardiumOccur during ventricular diastoleNormal perfusion to body occurs during systoleRCA
○ Supply right ventricle and inferior wall of left ventricle (bottom)
Left Main Splits to○ Circumflex
Supplies blood to posterior (back) and lateral (side)○ LAD
Supplies blood to anterior and Left ventricleCollateral circulation
○ Compensation for loss of O2 in other areas
Conduction System Controls the synchronous, rhythmic contraction
of the heart muscle SA Node
Sinoatrial node60-100 BPMPrimary pacemaker of heartRight AtriaInitiates atria contractionShows as P wave on EKG tracing
Internodal PathwaysTracts that the impulse takes from SA-AV node
Conduction System AV node
Atrioventricular node40-60 BPMConnects Atria to VentricleImpulse pulses here before heading to ventriclesPR interval
Bundle of HisSplits impulse to RBBB and LBBBSits in the Interventricular septum
Purkinje FibersInitiates myocardial contraction20-40 BPM
EKG Theory Measures electrical energy as it travels
through the heart Records as energy over time
Millivolts and Seconds EKG paper has small squares
1mm x 1mm5 small boxes = 5mm = 1 large box
Tracings are made by a stylus 1mm on y axis = 0.1mv 1mm on x axis = 40ms or 0.04 seconds
1ms = 0.001 seconds
EKG Theory EKG paper speed is 25 mm/sec
50mm/sec if rhythm is too fast○ Only change paper speed if ordered by MD
Standard AmplitudeAmplitude is change over a period of time10mm = 1mvGain is used to increase amplitude (size)
Calibration boxAt beginning of lead
○ Speed and amplitude○ Standard is 10mm tall and 5mm wide○ Gain of 1 = 10mm, ½ = 5mm, 2 = 20mm○ 25mm/sec = 5mm, 50mm/sec = 10mm
EKG Theory Refer to user manual and hospital policy
For paper typeCleaning (keypad, wires machine)Daily user testCorrect power supplyBio-engineer will calibrate machine if
needed
EKG Theory Einthoven’s triangle
Willem Einthoven○ Discover everything basic of
EKGs Bi-Polar Leads
I, II, III Unipolar leads
V1-V6Augmented leads
○ avF, avR, avF
Calculating Heart Rates 1500 method
Atria rate- count the P-P interval○ Small boxes between the P waves
Ventricle rate- count the R-R interval○ Small boxes between the R waves
1500/boxes Sequence method
AKA 300 method○ Count the large boxes between the R-R waves and
300/boxes○ 300, 150, 100, 75, 60, 50
Calculating Heart Rates 6 second rule
Good for estimating rate if R-R intervals are not regular
Count QRS complexes in 6 second strip and multiply by 10
Marks under tracing indicate 3 seconds
Artifact Wandering baseline
Most common cause is respirationsMove electrodes off torso and onto wrists and
anklesHave patient relax and breath slowly
SeizuresLarge artifactSeizures must be controlled before EKG can be
done Dry Skin
Electrodes might now adhere○ Use Benzoin to promote adhesion○ Abrade the skin
Artifact Wet Skin
Dry skinUse Benzoin to promote adhesion
Cold patientWarm patient with blanketMay have to do EKG with artifact
Dry GelUse new electrodes
Cell PhonesTurn them off, remove and place asideCan look like p waves often like A-flutter
Medical devicesTurn off or move away from EKG patientBe careful in the ER or ICU
Lead Locations 3 Lead
White- Right Shoulder or clavicle areaBlack- left shoulder or clavicle areaRed- Left lower abdomen areaGreen- Right lower abdomen area
5 LeadWhite- right sternum/clavicle areaBlack- Left sternum/clavicle areaRed- Left lower thoracic areaGreen- Right lower thoracic areaBrown- Just below and to the right of
bottom of sternum
Lead Locations Precordial Leads
V1- 4th ICS, Right of SternumV2- 4th ICS, Left of sternumV3- Between V2/V4V4- 5th ICS, midclavicularV5- 5th ICS, between V4/V6V6- 5th ICS, midaxillary
Right precordial leadsReverse V leads
Lead Locations Posterior Leads
V7- Left posterior axillary lineV8- Left midscapular lineV9- left of spine
Stress testLimb electrodes go on torso
Post EKG Check leads for deflection direction Check leads for artifact Check that patient identifiers are on EKG
NameDOBMedical record number
Upload EKG Via hospital policy Mount EKG or strip per hospital policy
Hole punch, scan or stick onto mounting paper
Measuring EKG’s Know how to be able to measure
P-P interval○ Time between Atria contractions
R-R interval○ Time between Ventricle contractions
PR interval○ Time from SA to ventricles○ 0.12-0.2 seconds
QRS○ Time for ventricles to depolarize○ 0.06-0.12 seconds
Parts of Waves Positive
Anything above isoelectric line Negative
Anything below isoelectric line PR segment
Time impulse travels through AV nodeEnd or P to beginning of QRS
ST segmentTime it take for ventricles to repolarizeEnd of QRS to end of T wave
Parts of Waves J Point
Point when ventricles depolarize and ventricle repolarize○ End of QRS
QT intervalTime it takes ventricles to depolarize and
repolarize
Sinus Rhythms P wave resent P wave upright and rounded QRS complex narrow
80-120 milliseconds PR 120-200 milliseconds Regular Sinus Rhythm
Rate 60-100 Sinus Bradycardia
Rate less then 60 Sinus Tachycardia
Rate greater then 100 Sinus Arrhythmia
Rate around 60-100Rhythm is irregular
Atria Rhythms P waves abnormal shaped or absent QRS complexes narrow Atrial Fibrillations
No P waves, No PR interval Rate 60-100 Irregularly irregular
Atrial Fibrillation with Rapid Ventricular No P waves, No PR interval Rate greater then 100 Irregularly irregular
Atrial Flutter P waves = Flutter waves (abnormal P waves) Rate varies Regular
Supraventricular SVT P waves often NOT seen Regular
Premature Atrial Complex PAC P wave abnormal QRS follows P wave NSR with PAC
Junctional Rhythms Starts at AV node or Bundle of His P wave absent or abnormal (inverted) QRS narrow or above 120 milliseconds Junctional Rhythm
P-wave absent or abnormal○ Rate 40-60
Junctional BradycardiaRate less then 40
Accelerated Junctional RhythmRate 60-100
Junctional TachycardiaRate above 100
Ventricle Rhythms QRS complex wide Idioventricular Rhythm
Wide QRS complexesRate 20-40
Ventricular tachycardiaMonomorphic
○ Wide QRS with rate above 120○ Complexes look identical
Polymorphic○ Complexes have different amplitude
Ventricular Rhythms Ventricular Fibrillation
No identifiable waves Asystole
Absence of electrical activity in the heart Premature Ventricular Complex
Wide QRS, absent P wavesR wave opposite direction of T waveNSR with PVCMultifocal PVCs
○ Different shaped PVCs○ Patterns – Bigeminy, Trigemity (every other or 3rd)
Heart Blocks Impulse is delayed or blocked as it travels to the
ventricles 1st degree
PR interval greater then 200 milliseconds 2nd degree type 1
PR interval elongates until dropped QRS complex 2nd degree type 2
PR interval normal if presentDropped QRS complex without warning
3rd degreeComplete lack of association between the atria and ventricles
○ P waves present at normal rate○ QRS waves at rate of Junctional rate or idioventricle
Could be wide or narrow
Injury Ischemia
ST segment depressionT wave inversion
InjuryST elevation
○ 1mm in limb leads○ 2mm in precordial leads
InfarctionST elevation will return to baselinePathological Q waves developPathological Q waves can indicate MI
Lead Locations for MI
ST segment Morphology Draw line from J point to top of T wave Convex
ST segment is above lineCan be Ischemia STEMI
ConcaveST segment is below lineCan be ischemia but often benign
ST segment sloping
T Wave T wave is peaked T wave is Hyperacute
Hight is greater then ½ the QRS T wave elongates
Cardiac Compromise Tachy or brady Pallor Diaphoresis Decrease in BP Breathing problems Anxiety or confusion Cyanosis Chest pain or tightness Back, arm, jaw pain Nausea and vomiting Lightheadedness Weakness Syncope
Left-threating arrhythmias Ventricular tachycardia
Check Pulse Ventricular fibrillation
Call for help Start CPR Use AED
Asystole Check in 2 leads Call for help Start CPR
Bradycardia Call for help Check Vitals Prepare patient for pacing
Tachycardia Call for help Check vitals Cardioversion
Pacemakers Paced Ventricular Paced Atrial-Ventricular
Patient Care Responsible for knowing patients
Medical History○ Smoking, alcohol, drugs, stress, exercise, nutrition, work
environment, family history, marital status, children○ Past medical conditions
Stroke, MI, Aneurysm, murmurs, PE, DVTs, Heart failure, hypertension, COPD, CHF
○ Current ComplainsPain, SOB, Edema, Palpitations, Fainting, Weakness
Surgical History○ What, when, complications (more details if cardiac)
Medication List (also allergies)○ Currently taking and recently stopped (last month or 2)○ Include OTC medications, birth control, erectile dysfunction
Patient Care Explain procedures fully with easy to
understand terms Explain purpose, length, steps of
procedurePreparation if test isn’t for today
Allow them to ask questions
Patient Care EKG
Allow physician to assess the electrical activity of the heart
Non-invasive, PainlessAround 10 minsWhat the electrodes are forEmpty pockets, relax, lay flat avoid moring
or talking
Patient Care Holter
Monitors activity for 24-72 hours Instruct patient to bathe rior to appointment
○ Pt can not remove electrodes or get device wet during time Loose fitting clothing to help prevent artifact Notify if irritation occurs from electrodes Normal daily activity
○ Including work exercise and sleep Journal with date time and duration of any symptoms
○ Lightheadedness, palpations, chest pain, SOB○ Note when medications taken, physical activity and sleeping
Patient to call physician office if electrodes fall off○ Electrodes get replaced by Tech NOT patient○ Batteries get changed by Tech NOT patient○ Electrodes get moved by Tech
Call 911 for serious symptoms
Patient Care Stress Test
Used to determine how the heart function under increased workload from exercise
Take about 10 minsElectrodes and Blood pressure during testBaseline EKG prior and end of testTest goes until
○ Symptoms occurLightheadedness, dizziness, SOB, Chest pain
○ Target heart rate reached or physician orders test to endPatient not to eat, drink or smoke 3 hours priorContinue normal medication unless instructed by physician to
hold medicationWear clothing and shoes for exercising
Patient Care Stress Test
Monitor for○ Vital Sings○ Arrhythmias○ Cardiopulmonary compromise○ Heart rate
Complications○ Most common is hypotension and arrhythmias○ Stop and let patient rest○ Lay patient down○ Report change to physician
Patient Care Telemetry
Continuous monitoring of electrical systemWithin hospitalNotify staff if symptoms occur
Vitals Check Pulse
Adult- RadialChild- Brachial Apex use stethoscope
○ 5th ICS midclavicularPulse oximeter
○ Used to determine amount of oxygen in blood○ Normal is above 95%○ Cant read if: cold hands, colored nails,
edema, fake nails
Vitals
Rhythms
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