In clinical work, the use of an electrocardiogram machine is absolutely mastered by nurses, because when a patient develops suspected cardiac symptoms such as precordial discomfort and chest pain, an electrocardiogram can be provided to the doctor in a timely and accurate manner. diagnosis is of great significance.
However, in the process of using the electrocardiograph, unfamiliar friends will always have various problems. I have summarized some of them.
First, Careful Handover Inspection
Check the completeness of the ECG machine before and after work shifts / ECGs are performed.
1.) Check whether the electrocardiograph is in charging state. The interface and plug of the power supply part should be fully inserted, so as not to delay the timing of drawing due to insufficient power to find the power supply.
2.) Check whether the probe connector of the chest wall leads is placed correctly. In particular, after the ECG is done, attention should be paid to the removal of the chest wall lead suction bulbs that are attached to the patient in time.
3.) The lead wire is smooth and easy to pick up. After the ECG is done, the chest wall leads can be removed first, and then the limb leads can be removed, so that part by part can be removed to prevent the lead wires from entangling and pulling each other and then time-consuming to comb.
4.) Whether the ECG chart is sufficient, and also know how to add paper to different types of ECG machines.
5.) Whether the coupling agent, normal saline, etc. are sufficient.
Second, the actual combat can take the trick
1.) How to place limb lead wires in patients with open limb fractures, amputation infections, and limb burns?
Answer: ① The limb leads can be clamped at the proximal/distal end avoiding the wound, or even the electrodes can be tied anywhere on the limbs distal to the shoulder joint and groin.
②If it cannot be clamped on the limb, pull out the lead wire tail pin connected by the lead clip and stick it on the skin of the limb (the skin is clean) to record.
2.) What should I do if the cardiac arrest patient is undergoing chest compressions and needs to have an electrocardiogram recording?
Answer: As long as the limb leads are connected (it has nothing to do with the connection of the chest wall leads), the limb lead ECG can be recorded, but if the limb leads are not connected, it is not necessary to record the chest wall leads alone. possible.
We can freeze the ECG when judging the patient’s condition (no more than 10 seconds after stopping compressions).
3.) What should I do if the suction ball of the chest wall lead wire is accidentally lost?
A: Pull out the lead wire tail needle connected by the lead clip and stick it on the patient’s skin.
4.) On the basis of 12-lead, what should I do if the ECG machine is a 12-lead ECG machine?
Answer: After the conventional 12-lead ECG is done, connect the V1-V3 electrodes of the chest leads to V3R, V4R, and V5R respectively (on the right anterior chest), and use the V4-V6 electrodes to connect to the V7, V8, and V9 leads respectively (on the left rear). back). The limb leads were not removed, and an electrocardiogram was recorded again.
5.) In addition to recognizing and reading the English abbreviations clearly, are there any tricks and formulas to identify the leads, so that the lead installation is not confusing?
Answer: Limb lead: again (right) red and (right) black, emperor (yellow) on green (bottom)
Note: What we read first is the one installed on the top, red on the upper right, black on the lower right, yellow on the upper left, and green on the lower left. Manufacturers of electrocardiogram recorders follow this color “convention”.
Chest wall leads: red-yellow-green, brown-black-purple. The more you study, the more you must keep in mind.
6.) The skin of the elderly is dry and loose; how can it be fixed?
The suction bulb/patch cannot make a stable and clear ECG with normal saline on such skin, and coupling agent can be applied.
In addition, in the process of doing ECG, we must pay attention that the patient is a human, not an unconscious teaching aid, and a restless patient will not cooperate.
Therefore, when I do ECGs for patients, I will emphasize good communication and communication; for example: “We will do the ECG, please don’t move or talk, it will be over soon”, “It’s a little cold, please cooperate with me. “, “Don’t be nervous, breathe slowly” and so on.
After the operation, it is necessary to carefully clean the skin of the patient and organize the patient’s clothes, especially for female patients, to avoid unnecessary disputes.
The ECG should be marked with the patient’s name, gender, bed number, and medical record number in a timely and accurate manner, and the patient’s vital signs should be recorded as prescribed by the doctor.
Excluding personnel and technical problems, the problem of poor contact of various components of an old electrocardiograph is also worth noting.
Therefore, cleaning and maintaining the ECG machine is also a must, so that the next colleague who takes over the ECG machine can have a smooth start.
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