# Tips For Getting Good EKG



## Simusid (May 12, 2010)

I'm the basic on a PPB truck.   We have Zoll M CCT defibs that are either 5 or 6 years old.  I have seen a fair number of problems getting good traces on many runs.   I'm new and I generally believe the more senior guys know what they are doing.   It could be the leads, it could be the pads, maybe they could prep a little better, maybe it's the defib getting old.   I don't have enough experience to say.   So I've got two questions.  

1)  What is the first thing you think of when you see a bad/noisy EKG?   What do you try to fix?  How carefully do you prep the site for the pad?

2)   How many years should you expect a top tier defib (I'm assuming that a Zoll M is a pretty good unit) to last assuming regular maintenance and decent care?


The gang wants new Lifepak 15's and I may only be a basic, but I'm one of the guys that signs the checks and I'd rather not spend $50k if I don't have to!


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## MonkeySquasher (May 13, 2010)

Simusid said:


> I have seen a fair number of problems getting good traces on many runs....It could be the leads, it could be the pads, maybe they could prep a little better, maybe it's the defib getting old.



Pull it out of the slot, blow in it, and put it back in forcefully.

...Oh wait, that was the old Nintendo NES cassettes...   Nevermind.  B)


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## medic417 (May 13, 2010)

Search this site and will find advise for this to include turning off all electrical in ambulance,  Turning off ambulance, shaving patient, abrading skin with something like 3m skin prep (looks like roll of scotch tape), use fresh electrodes, etc etc etc.


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## LondonMedic (May 13, 2010)

Where possible, place the electrodes on bony prominences like the humeral heads, pelvis, malleoluses, etc.

Relax the punter first, or wait until they're calmer.

Warm them up if they're cold.

Use the filter.


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## mycrofft (May 13, 2010)

*Look to your wires and electrodes too.*

1. Once a defib electrode is torn open, it is a case of use it immedidately, or use it for training. Once a pack of EKG electrodes is opened, seal the remainder, while still in their original package, in a ziplock baggie. Watch your outdates and try not to leave them where they will get super hot. If they have visible changes in their sticky gel, discard or use for training. (They may contain enough silver to be recycled at your local photographiuc film developer's).
2. Make sure the clips or snaps on the end of any wiring harnesses which end in electrodes are free of corrosion, bits of sticky stuff or dried gels etc. Anything interfering with those connections can cause a wandering tracing for that electrode, or block it entirely.
3. If you machine has standing wiring harnesses leading to the pt (as opposed to one-time harnesses), have a way to test your wiring harnesses, or rotate them out periodically. Check every point where there is a connection for corrosion, damage, losse fittings, spooge, etc. 
4. Watch for damage at the machine if the pt wiring harness gets yanked. It can bend connectors, or even snap the connection from the mother board, depending upon construction. 

At my work, albeit not mobile, we were using ten year old WelchAllyn machines with good result once people stopped yanking the paper off incorrectly, and started maintaining the electrode clips.


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## reaper (May 13, 2010)

LondonMedic said:


> Where possible, place the electrodes on bony prominences like the humeral heads, pelvis, malleoluses, etc.
> 
> Relax the punter first, or wait until they're calmer.
> 
> ...



Do you have any research on this?

I have talked with everyone from Cardiologist to monitor techs. They all have said the same thing. They were all taught to avoid bony prominences at all cost. The bone will interfere with the electrical conductivity!


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## LondonMedic (May 13, 2010)

reaper said:


> Do you have any research on this?
> 
> I have talked with everyone from Cardiologist to monitor techs. They all have said the same thing. They were all taught to avoid bony prominences at all cost. The bone will interfere with the electrical conductivity!


Nope, just my experience and education.


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## Simusid (May 13, 2010)

reaper said:


> Do you have any research on this?
> 
> I have talked with everyone from Cardiologist to monitor techs. They all have said the same thing. They were all taught to avoid bony prominences at all cost. The bone will interfere with the electrical conductivity!



I was definitely trained to avoid the bony sites.


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## MrBrown (May 13, 2010)

Take your time

Make sure the patient is still (use the lost art of talking to make them chillax)

Use new fresh leads and make sure there is a bit of slack in the monitor cables

Proper electrode placement

Don't do it next to the electrical substation or while the ambo is moving

Know what a poor ECG looks like and how to fix it

etc


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## LondonMedic (May 14, 2010)

reaper said:


> I have talked with everyone from Cardiologist to monitor techs. They all have said the same thing. They were all taught to avoid bony prominences at all cost. The bone will interfere with the electrical conductivity!


Yes, bones do not conduct as well as muscle, however, in a patient who is tremulous (cold, 'shock', EtOH or whatever) they will be moving less. This is your trade off between amplitude and artifact.


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