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INTRODUCTION

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Few improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment, cardiopulmonary resuscitation (CPR), can be performed without extra equipment. However, not even MacGyver would really be willing to try cardioversion without a defibrillator, and the most basic treatments used for cardiovascular care require at least certain medications and equipment.

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DIAGNOSIS: ELECTROCARDIOGRAM

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No Calipers

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To measure electrocardiogram (ECG) intervals without calipers, mark a card or piece of paper with vertical lines: | | | | | | | | |. The marks can be spaced to match the top of the R or the P waves, depending on what you are looking for. Move the marks to another part of the ECG to determine if the rates are constant or to find a P wave hidden in a QRS complex.

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Alternate Electrocardiogram Positions and Leads

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If there is no room to lay a patient down, do the ECG with the patient in a standing position (Fig. 10-1). The resulting ECG is just as interpretable as one done in a supine position.

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FIG. 10-1.

Standing ECG with improvised leads.

Graphic Jump Location
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Attaching Electrocardiogram Leads
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If an ECG or a cardiac monitor is available, but the way of attaching the leads to the patient is missing, several methods work well. The key is to pull off any device hiding the bare metal leads (that usually are covered by devices that attach to tape leads on Western ECG machines). After removal, place the leads directly on small alcohol or saline pads or a lubricant (oil, K-Y jelly) between the skin and the lead, but that is not essential to obtain a good ECG reading. Affix them in the normal locations using phlebotomy tourniquets. If chest leads are needed, place these on the skin in the same manner, using tape to temporarily secure them. If they must be kept on for some time or if the patient has injuries (e.g., burns) precluding the use of tape, insert small-gauge needles just beneath the epidermis and use alligator clips to make a connection (Fig. 10-2).

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FIG. 10-2.

Electrocardiogram leads attached using a variety of improvised methods.

Graphic Jump Location
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“12-Lead” Electrocardiogram Using 3 Leads
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Normal 12-lead ECG machines may not be available when additional ECG information is needed for a diagnosis. In this situation, clinicians can use a 3-lead machine to obtain an ECG tracing that produces most of the information provided by a 12-lead ECG. To do this, do a tracing with the ECG pads placed in the normal 3-lead positions:

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  • White = right chest just below the clavicle

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