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.
To measure electrocardiogram (ECG) intervals without calipers, mark a card or piece of paper with vertical lines: ||||||||. The marks can be spaced for 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.
Alternate ECG Positions and Leads
If there is no room to lay a patient down, the ECG can be done with the patient in a standing position (Fig. 10-1). The resulting ECG is just as interpretable as one done in a supine position.
Standing ECG with improvised leads.
If standard ECG leads are not available, leads can be attached using needles (as is often done for burn patients) or by simply holding the bare ends of the leads down with venous tourniquets or tape. If the leads have been modified to hold a tape lead, just pull that lead straight off. You can use alcohol pads or a lubricant (oil, KY jelly) between the skin and the lead, but that is not essential to obtain a good ECG reading (see Fig. 7-15).
"12-Lead" ECG Using 3 Leads
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:
- White = right chest just below the clavicle
- Black = left chest just below the clavicle
- Red = left lower abdomen just above the umbilicus
Then, do four more tracings, each time moving the Red (Left Leg) lead to the V1, V2, V3, or V6 positions (Fig. 10-2).1 Many monitors can also show leads II, III, aVL, aVR, and aVF by moving a dial on the machine with the leads kept in their normal position.
A normal ECG (I, V1, V2, V3, V6) done using only the three leads from a monitor. The additional limb lead tracings taken by changing settings on the monitor are not shown. ...
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