12 Lead Ecg (Ali Haedar)
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Department of Emergency MedicineDepartment of Emergency Medicine
Saiful Anwar General HospitalSaiful Anwar General Hospital
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ECG 12 LEADTUJUANAnda akan belajar :Mendeskripsikan bagaimana ECG
membantu dalam mendiagnosa kondisi yang patologis
Bagaimana menyiapkan pasien, menempatkan elektrode, & merekam ECG 12 lead
Bagaimana mengatasi permasalahan dan merawat mesin ECG
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ECG 12 LEADSMerekam aktivitas listrik melalui
elektrode yang ditempatkan pada titik-titik tertentu
Memberikan gambaran yang lebih lengkap daripada sebuah strip irama
ECG serial dapat mendokumentasikan perubahan aktifitas jantung dari waktu ke waktu
Dapat mendiagnosa Angina & IMADapat mengkaji fungsi dari ventrikel kiri
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BIPOLAR LEADSTiap sandapan
menunjukkan 1 area dari jantung
sandapan extremitas mendeteksi arus dari extremitas & merekan ECG dlm bidang frontal
Lead I, II, III sandapan bipolar
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UNIPOLAR LEADSaVR, aVL, & aVF
adalah sandapan unipolar
Elektrode positifMendeteksi arus
pada pusat jantung yang bermuatan netral
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Sudut pandang jantung yang dapat dimonitor melalui sandapan
Lead Sudut pandang
I, aVL, V5, V6 Lateral
II, III, aVF Inferior
V1 – V4 Anterior
AVR Tidak melihat dinding jantung, hanya melihat dasar jantung
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PEREKAMAN 12 LEAD ECGPenjelasanBeri penjelasan bahwa dokter menghendaki
pemeriksaan ini & jelaskan prosedurnyaYakinkan pasien bahwa prosedur ini aman & tidak
menyakitkanJawab pertanyaan & berikan kenyamanan pada
pasien
Persiapan pasienBaringkan pasien dengan lengan berada di sampingTinggikan bed jika pasien kurang nyamanJaga privasi, buka baju di bagian lengan, kaki &
dada
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Memilih penempatan elektrodePilih bagian tubuh yang datar; hindari
yang berotot dan bertulangBersihkan daerah penempatan elektrode
jika perluKesalahan penempatan > 1.5cm dapat
memberikan interpretasi yang salahMESINSingle channelMulti channel merekam 12 lead & strip
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MASALAH DALAM PEREKAMAN & PENYELESAIANNYA
Gangguan ACkontak yang jelek gosok kulit
pasienpenempatan ground yang tidak benar
perbaiki ground, pindah stop kontak ke tempat yang lain
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Wandering Baseline
Pasien bergerak - anjurkan pasien rilexElektrode bergerak - cek kabel, mungkin
tidak menempel pada elektrodeKontak yang jelek & persiapan kulit yang
tidak bagus - ulangi pemasangan & gunakan tombol “filter”
gangguan dari pernapasan - pindahkan dari daerah dengan pergerakan napas besar
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Tremor/artefak otot
Kotak & penempatan elektrode yg jelek - bersihkan & pasang ulang
Pasien kedinginan - hangatkan pasienPasien tegang & tidak nyaman -
tenangkan pasien & tekan tombol “filter”Tremor - gerakkan elektrode dari area
yang berotot
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Kualitas print/gambar yang jelek
Print head yang kotor OR tinta habis - ganti print head atau stylus (jarum)
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PERAWATANBersihkan permukaan luar &
asesorisnya dengan alkohol kecuali kabelBersihkan kabel & bagian luar dengan
sabun & air atau desinfektan ringan. Alkohol akan membuat kabel rapuh
Jangan Menggunakan
larutan kuat, iritatif, bahan dasar iodine, fenol, amonia, bahan pemutih (chlorine)
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Quick Quiz1. The chest leads are placed:
a. Starting with the fourth intercostal space at the right sternal border
b. Starting with the fourth intercostal space at the left midaxillary line
c. Starting with the fourth intercostal space at the midscapular line
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1. Answer:a) Lead V1 is placed anteriorly between the fourth
and fifth ribs at the right sternal border. Lead V2 to V6 are then placed accordingly.
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Quick Quiz2. A 12-lead ECG is used to assess function of
the:a. Right ventricleb. Left ventriclec. 12 views of the heart at the same time
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2. Answer:b) A 12-lead ECG gives a more complete view of the
heart’s electrical activity than a rhythm strip and is used to assess left ventricular function
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Quick Quiz3. AC interference is due to:
a. Interference from other poorly grounded equipment
b. The machine plugged into the wrong socketc. The wrong voltage being used
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3. Answer:a) Other poorly grounded equipment will cause
disturbances and prevent a good quality signal from being received by the cardiograph.
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Quick Quiz4. If water is poured over the cardiograph
accidentally:a. Use a hairdryer to dry the machineb. Call the agent to service the machinec. Switch off the machine immediately you will get
electrocuted
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4. Answer:b) Call the agent immediately because water will
damage the internal circuitry of the machine.