Chapter 1 Role of the Electrocardiographer. The number one cause of death in the United States is...
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Transcript of Chapter 1 Role of the Electrocardiographer. The number one cause of death in the United States is...
The number one cause of death in the United States is cardiovascular disease
500,000 deaths every year due to coronary artery disease
More than one in five Americans suffer form heart disease
ECG/EKG – Electrocardiogram – diagnostic tool giving information r/t: heart disease, abnormalities, rate, rhythm, electrical activity of the heart
Role of the Electrocardiographer
Reasons to perform EKG’s1. Determination of pumping/contraction2. Check flow of electricity thru the heart3. Diagnose changes in heart rhythm4. Check for abnormalities before surgery5. Physical exam after age 40/Health Evaluation6. Monitor/evaluate individuals with heart conditions
An inaccurate tracing could result in a wrong decision about medication or treatment which could result in a negative outcome for the patient
Role of the Electrocardiographer
Major Risk factors for Heart DiseaseFactors that are unchangeable1. Increasing age: 4 of 5 who die > 652. Older women 2x more likely to die than men3. Gender: Men > risk earlier, after
menopause, death rate for women increases4. Heredity (including race) Children of
parents with heart disease more likely to develop CAD / African Americans > hypertension > risk
Role of the Electrocardiographer
Factors that can be changed:1. Cigarette and tobacco smoke 2x > risk2. High Blood Cholesterol levels3. High Blood Pressure – coexisting obesity,
cholesterol, smoking = several times the risk4. Physical Inactivity5. Obesity / Overweight – even without other
factors6. Diabetes7. Stress – may lead to overeating, smoking,
increased smoking
Role of the Electrocardiographer
History of the EKG1676 – Discovery animals generate electricity1887 – Dr. Augusta D. Waller – credited with
first EKG on a humanEinthoven – First practical galvanometer, in
1903, invented the first EKG / Nobel Prize 1924
Dr. James B. Herrick – 1918 abnormal tracing and symptoms could indicate MI, heart attack
Today: nurses, physicians, medical assistants,RT’s, radiology personnel, PCT’s perform EKG’s
Role of the Electrocardiographer
Wilhelm Einthoven1867-1927
The ECG Technician is an individual who records the EKG and prepares the report for the physician and should be able to:
1. Determine if the tracing is accurate2. Recognize abnormalities caused by interference3. Report abnormalities to the nurse or physician4. Maintain patient rec ordsMost EKG Technicians are:5. Employed in hospitalsEKG Technicians may work in:6. Medical offices7. Cardiac rehab centers8. Home health care9. Telemetry Centers (monitor Tech)
Role of the Electrocardiographer
EKG Techs may wish to advance their training and become a CARDIOVASCULAR TECHNOLOGIST
Assist physicians with invasive cardiovascular diagnostic tests such as:
1. Angioplasty2. Heart surgery3. Implantation of artificial pacemakers4. Ultrasound of blood vessels5. Also perform EKG’s
Role of the Electrocardiographer
How ECG’s are used:Looking for changes from a normal tracing,
or the first EKG tracing done (baseline comparison)
As part of an annual physical for patient’s over 40
Used in a number of healthcare settings such as – acute care (ICU, ER), EMS, Transmitted over a telephone from home, clinics, etc.
Role of the Electrocardiographer
In the Hospital (Acute Care)12 Lead EKG, most common in hospitalsMay be routine, or Code Blue (cardiac arrest)Emergency (STAT) immediately – patient may be having
chest pain, or a change in rhythmRoutine are done usually early morning so MD can see
on morning rounds, also pre-op EKG’s are routineContinuous monitoring – ICU, CCU, SINU, ER, Recovery,
OR, may get O2 sats. and vital signsAn inaccurate tracing may result in: misdiagnosis,
medication errors, serious adverse outcomes REMAIN calm during STAT EKG’s, avoids
stress/confusion
Role of the Electrocardiographer
TELEMETRY – a type of continuous monitoring
Monitor usually in a small case with electrodes attached to the patient’s chest
Can usually ambulateTracings are transmitted to a central location
for monitoring and evaluation (telemetry station)
Role of the Electrocardiographer
Conditions Evaluated by the EKG 1. Disorders in heart rate, rhythm, or conduction 2. Electrolyte imbalance 3. Condition of heart prior to defibrillation 4. Damages assessment during/post MI 5. Structural heart or coronary blood flow disorder 6. Evaluation of CP, SOB, weakness 7. Dx of certain drug toxicities (digitalis) 8. Dx metabolic disorders: K+, CA++, acidosis (pH),
hypothyroidism 9. Pre-operative eval in asymptomatics or at risk pt. 10. Damage assessment pot chest, head, spinal c. trauma 11. Assessment of cardiotoxic / antiarrhythmic drugs 12. Suspicion of congenital heart disease 13. Pacemaker function
Role of the Electrocardiographer
Treadmill Testing – AKA Exercise Electrocardiography
Determines whether the heart is receiving adequate blood during stress or exercise
A physician should always be presentSafe, inexpensive, reliable___________________________________________Holter Monitor – small box and electrodes –
24-48 hours during patient’s normal daily activity
Role of the Electrocardiographer
DefibrillationIf an abnormal pattern requires immediate
treatment, cardiac medications are administered, or a defibrillator is used
A defibrillator produces an electrical shock intended to correct the hearts electrical pattern (AED or Lifepack) AED Layperson, Lifepack – emergency personnel
Transtelephonic monitoring: Used up to 30 days – Smallest available: size and shape of a beeper with 2 electrodes – one type is applied as symptoms occur – left arm wristwatch or credit card type
Role of the Electrocardiographer
What do you need to know to perform and EKG?
ProcedureEKG machineAbility to lift and move patientTransport and operate the EKG machineUnderstand principles of safety / infection
control / patient education / communication / law / ethics
Ability to troubleshoot procedural problems
Role of the Electrocardiographer
UNIVERSAL PRECAUTIONSGuidelines to prevent the spread of infectionEssential to prevent the spread of infectionBased on recommendations by the CDCMandated by OSHAUsed for all patients with or without infections____________________________________________STANDARD PRECAUTIONSPracticed on patients with known or suspected
infectionsCombination of Universal Prec. and BSI
Role of the Electrocardiographer
BODY SUBSTANCE ISOLATIONRecommended by the CDCReduces the risk of disease transmission of
pathogens from moist body substancesStandard Precautions apply to… blood, all body
fluids, secretions, and excretions except sweat regardless of whether or not they contain visible blood, nonintact skin, mucous membranes
SP require use of barriers: PPE, gloves, gowns, masks, eye protection: SP’s apply to isolated patients with known or suspected infections
Role of the Electrocardiographer
UP Hand WashingAfter touching blood, bodyfluids, secretions, excretions, Contaminated itemsBefore putting on glovesAfter removing glovesBetween patient contactsBetween tasks and procedures on the same patient
Role of the Electrocardiographer
UP Gloves: Wear gloves when: touching blood, body fluids, secretions, excretions, and contaminated items
Touching mucous membranes and nonintact skin
Change gloves: Between procedures and patients, after contacting materials that are highly contaminated
Remove gloves: Promptly after use, before touching
uncontaminated surfaces and items,WASH YOUR HANDS IMMEDIATELY AFTER GLOVE REMOVAL
Role of the Electrocardiographer
Masks, Eye Protection, Face ShieldsProtects mucous membranes of themouth, eyes and nose from splashesand sprays
Role of the Electrocardiographer
Wear mask, eye protection, and face shields during procedures and tasks likely to cause splashes, sprays of blood, body fluids, secretions and excretions
GOWNSProtect the skin and clothingWear expecting sprays,
splashes, blood, body fluidsRemove promptlyWash hands STAT after
gown removal
Role of the Electrocardiographer
EQUIPMENTMay be soiled / blood, body fluids, secretions, excr.Reusable equip. must be cleaned, disinfected, or
sterilized before use on another patient.Discard single-use equipment promptly
ENVIRONMENTAL CONTROLFollow facility procedures r/t surfaces, equip., etc
OCCUPATIONAL HEALTH and BBPUse resuscitation devices for mouth to mouth / CPR
Role of the Electrocardiographer
HANDWASHINGThe single most important procedure you can
perform to prevent the spread of infection. When practicing Universal Precautions and wearing gloves, you must wash your hands before putting gloves on and after removing them to prevent disease transmission
Role of the Electrocardiographer
Patient Education and CommunicationKey to success in recording and EKGA positive relationship and environment reduces
apprehension, anxiety and fearClearly explain the procedureAnswer questionsFriendly, confident mannerCooperation increase if pt. trusts you are
competentUse simple terms, speak slowly and distinctlyRepeat the instructions as needed
Role of the Electrocardiographer
HARD OF HEARING !!!!! Look directly at the patient Speak slowly Speak distinctly May be able to read your lips
____________________________________________________________
LANGUAGE other than English
Interpreter or family member
Role of the Electrocardiographer
LEGAL and ETHICAL ISSUESLaws are rules of conduct enforced by a
controlling authority such as the governmentUnlawful act consequences: job loss, fine, jailEthics are concerned with standards of
behavior and concepts of right and wrongEthics are based upon moral values formed
thru the influence of family, culture, societyIllegal acts are always unethical, unethical
cats are not always illegal
Role of the Electrocardiographer
PRACTICING ETHICSStandards of behavior or conduct defined by a
professional groupConfidentiality (HIPPA) – a breach in confidentiality is
both illegal and unethicalTreat patients with respect and dignityRespect privacy at all timesAvoid physical exposure – close door, drape, pull curtainRespect beliefs, values, and moralsContinue to learn and provide professional careWork cooperatively with co-workers and supervisors at
all times
Role of the Electrocardiographer
Legal Issues:Healthcare Professionals are legally responsible for
for his or her performanceAssumes accountability for1. performing unlawful acts2. performing legal acts improperly3. failing to perform an act when they should_____________________________________________Never speak defamatory words about a patientDerogatory remarks which jeopardize a reputation or means of livelihood is called slanderWriting defamatory words is called libel
Role of the Electrocardiographer
REQUIRED Entries for the Medical RecordPt. I.D., Full Name, SSN, birth date, full address, telephone
number, marital status, place of employmentMedical HistoryDates/Times all appointments, admissions, discharges, and
diagnostic tests such as an EKGDiagnostic Test Results (labs)S/S, reason for appointmentPhysician exam notes, findings, patient instructionsMedications, prescriptions given, refillsAll informed consents and for specific procedures and
treatmentsLegal Guardians, representatives as needed for consent
Role of the Electrocardiographer