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12 Lead ECG

Clinical Indications: Last update 02/2009

    Suspected cardiac patient
    Suspected overdose
    Electrical injuries
    Chest, Abdominal, or Thoracic Pain
    Shortness of Breath

Note: any patient getting a 12 lead, should have minimum of 2 done while patient is under care of prehospital providers (if time allows)


    1. Assess patient and monitor cardiac status.
    2. Administer oxygen as patient condition warrants.
    3. If patient is unstable, definitive treatment is the priority. Do not delay transport of critical patient for 12 Lead.
    4. Prepare ECG monitor and connect patient cable with electrodes.
    5. Enter the required patient information (patient name, age, and incident number.) into the 12 lead ECG device.
    6. Expose chest and prep as necessary. Modesty of the patient should be respected.
    7. Apply chest leads and extremity leads using the following landmarks:
      RA -Right arm
      LA -Left arm
      RL -Right leg
      LL -Left leg
      V1 -4th intercostal space at right sternal border
      V2 -4th intercostal space at left sternal border
      V3 -Directly between V2 and V4
      V4 -5th intercostal space at midclavicular line
      V5 -Level with V4 at left anterior axillary line
      V6 -Level with V5 at left midaxillary line
    8. Instruct patient to remain still.
    9. Press the appropriate button to acquire the 12 Lead ECG.
    10. If the monitor detects signal noise (such as patient motion or a disconnected electrode), the 12 Lead acquisition will be interrupted until the noise is removed.
    11. Once acquired, transmit the ECG data by fax to the appropriate hospital.
    12. Contact the receiving hospital to notify them that a 12 Lead ECG has been sent.
    13. Monitor the patient while continuing with the treatment protocol.
    14. Download data as per guidelines and attach a copy of the 12 lead to the PCR.
    15. Document the procedure, time, and results on/with the patient care report (PCR)

Competency Based Skill Requirements:

    Successfully complete an annual skill evaluation inclusive of the indications, contraindications, technique, and possible complications of the procedure.

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