According to the American Heart Association, the heart of a healthy adult beats 60 to 100 times per minute. The heart rate of a highly active person can usually beat as low as 40 times per minute.
The ECG readout on the patient monitor is not intended for detailed ECG analysis as it typically only represents one lead (most commonly lead II). Instead, it is most useful for guiding acute resuscitations or managing arrhythmias, since it can give you some information on the electrical activity of the heart and its level of function. If you have any concerns regarding a patient’s cardiac function, get a 12-lead ECG!
The lead placement procedure that is utilized has a direct impact on the quality of an ECG waveform. Electrode sites should be clean, dry and should provide a smooth flat surface.
3-wire Lead Place RA, LA, LL. Monitor one of three ECG vectors (I, II, or III).
5-wire Lead Place RA, LA, LL, RL, V1. Monitor seven ECG vectors (I, II, III, aVR, aVL, aVF, and V).
12 Lead Placement (recommended AHA) 12 Lead utilizes a 10-wire ECG lead set that can monitor 12 ECG vectors (I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6) simultaneously.
RA electrode under the right clavicle, mid-clavicular line within the rib cage frame. LA electrode under the left clavicle, mid-clavicular line within the rib cage frame. LL electrode on the lower left abdomen within the rib cage frame. RL electrode on lower right abdomen within the rib cage frame.
V1 chest lead in the fourth intercostal space, right sternal border. V2 chest lead in the fourth intercostal space, left sternal border. V3 chest lead midway between V2 and V4 on a straight line. V4 chest lead in the fifth intercostal space, mid-clavicular line. V5 chest lead in the fifth intercostal space, anterior axillary line. V6 chest lead in the fifth intercostal space, mid-axillary line.
2. Respiratory Rate (RR) : 12-20 breaths per minute.
Respiratory Rateis measured through the white and red limb leads of the ECG module. A patient’s respiratory rate is the number of breaths they take per minute. The average respiration rate for an adult at rest is 12 to 16 breaths per minute. If a patient’s respiratory rate is under 12 or over 25 breaths per minute while they lay in bed, doctors consider their breathing abnormal.
3. Peripheral oxygen saturation (SpO2) : 95-100% in room air.
Measurement of peripheral oxygen saturation (SpO2) is used to identify early hypoxia in patients and evaluate the effectiveness of oxygen therapy. Remove nail polish or acrylic nail from digit to be used and placing a probe on the patient's finger, toe or ear lobe. A SpO2 level of less than 90% is a clinical emergency. If the SpO2 level is below 94%, the nurse should assume the patient is hypoxic until proven otherwise, and therefore they may require supplemental oxygen administration. However, it is important to remember that some populations such as those with COPD have a lower normal cutoff.
4. Invasive Blood Pressure (IBP)
The invasive, arterial line (A-line)/Arterial Blood Pressure (ABP) method uses a catheter inserted directly into the artery and connected to a pressure sensor, and this method is considered the gold standard of continuous BP measurement. The usual method ofinvasive blood pressure monitoring consists of the percutaneous insertion of a small-bore (18- to 22-gauge) plastic catheter into aperipheral artery.
ABP measurement the systolic pressure will read slightly higher and diastolic pressure slightly lower (5-10mmHg), when compared to the same non-invasive measurements. It gives beat by beat near real-time measurement which permits the rapid recognition of blood pressure changes.
Dampingin cath lab.
It is the deformation of the normal arterial pressure curve, with a blunting of both systolic and diastolic pressure that drops compared to aortic pressure. Extreme damping can mimic a straight line with few wavy undulations. It means the forward flow is impeded as the catheter might be blocking the coronary flow at least partially, if not completely. Immediate pull back and adjustment of catheter is required to prevent adverse events that includes cardiac arrest. (Of course, catheter kinks, blocks, and air in a circuit are to be ruled out first)
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Mechanism of damping
The catheter tip is too large for the ostium.(Technical)
A left main or RCA ostial lesion*(Most significant clinically)
The coronary artery wall is thin and goes for spasm
Catheter diameter is too small and glides into the coronary artery (The catheter tip hitches against the lateral wall of the coronary artery often over a plaque, a silently staged perfect setting for a dissection )
Unique features in RCA damping
In RCA, damping could simply mean it has engaged conus branch. Damping is more common in RCA and it tends to get sucked in deeper for two reasons. We know, the RCA catheter is not preformed, the tip seeks the ostium, looking for a negative pulling pressure from within the RCA. Further, unlike the LCA, the flow in RCA is continuous in both systole and diastole. Another possible factor is the inspiratory swings of RV transmural pressure is more than LV.
Transient bradycardia due to compromise of SA /AV nodal flow is common. It is well known that RVOT is a thin and VPD-prone zone , compared toLVOT. Hence it is more vulnerable to ischemia and triggers a VT/VF if damping is prolonged in RCA.
5. Non Invasive Blood Pressure (NIBP)
A normal blood pressure level is less than 120/80 mmHg.
Non-invasive blood pressure (NIBP) measurement uses a pressurized cuff around the arm or the leg. As NIBP can be obtained by sending air pressure to the cuff and releasing it alternately, continuous BP monitoring is impossible.
