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Category: EMS Operations

Topic: Monitoring Devices

Level: Paramedic

4 minute read

Continuous ECG Monitoring

Purpose: The electrocardiogram (ECG) is a vital tool in the EMS toolkit, providing a real-time examination of the heart's electrical activity. This unit will delve into the purpose, indications, and practical applications of ECG monitoring.

Indications: ECG monitoring is crucial for patients presenting with cardiac-related signs and symptoms or potential signs and symptoms of illnesses with a cardiac impact. It's akin to having a window into the heart's function, allowing paramedics to make informed decisions about patient care.

Tools: The primary tool for ECG monitoring in the field is a combination ECG monitor/defibrillator. The 12-lead ECG provides information that can identify ischemia or infarction.

ECG Paper Speed: The ECG paper speed is typically set at 25 mm/sec. Each 1 mm (small) horizontal box corresponds to 0.04 seconds (40 ms), grouped into larger boxes containing five small boxes, representing 0.20 sec (200 ms).

Leads: There are three types of leads: bipolar, augmented, and pre-cordial. Leads I, II, and III, also known as the limb leads, are the bipolar leads. Lead II and Modified Chest Lead 1 (MCL-1) are the most common monitoring leads. Lead II is often used because most of the heart's electrical current flows toward its positive axis, providing the best view of the ECG waves and the conduction system's activity. MCL-1 is occasionally used and is often better for determining the site of ectopic beats.

Communication: Always remember to explain to the patient, family, and any significant others what is being done and why, especially with treatment for vascular disorders or in any other emergency. Communication with and transferring data (ECGs, vital signs, etc.) with the receiving hospital and physician is paramount.


INTERPRETATION: [SEE Medical Emergency: Cardiology]