Getting a clean 12-lead EKG is imperative to be able to properly read one. Artifact can have many causes.
The first thing to check: Is your patient resting their arms, legs and head? Are they as relaxed as possible while the machine is obtaining the 12 lead? Are you in a moving truck? Holding any part of the body up causes muscle tension and can decrease the quality of the EKG. You may need the patient to lay back a bit so they can relax better.
Please check out this excellent publication by Physio Control on how to Minimize ECG Artifact. It explains quite a few of those squiggles that you see. (Please don’t use sandpaper on your patients. You can dry the area with a washcloth or 4×4 but no stopping at Home Depot for sandpaper.)
Here are some other 12-Lead reminders for both BLS and ALS providers:
- Don’t forget to send your 12-lead to the receiving hospital (even if it doesn’t say STEMI) and make sure you upload the 12-lead and other Lifepak data to your patient report.
- Remember to bring the Lifepak in the house with you. You should obtain the 12-Lead within 10 minutes or less of patient contact.
- Agreeing to the manual override should only be used as a last resort and after you have tried everything else to get a good tracing. Troubleshoot as much as you can before falling into the “easy” button trap.
- All patients with non-traumatic chest pain who are 35 years or older should receive a 12 lead. Even if you think it is something else, if you are checking the primary impression of chest pain (non trauma), angina, STEMI or other cardiac chest pain, you should be obtaining a 12-lead. Other patient presentations may also warrant a 12 lead. Refresh your memory with this (and please include post cardiac arrest patients as well): VBEMS.WhoRequiresa12Lead
Obtaining a high quality EKG and transmitting it to the hospital (as soon as you obtain it when it shows a STEMI) will allow for better patient decisions and literally can save their life!