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Skip to 0 minutes and 13 seconds We’ve reached a point where we can actually now switch on the machine to record the ECG. We’ve placed our electrodes, we’ve carefully placed our leads. Our patient is still comfortable. Is that so, Mark? That is correct. Excellent. Thank you. So I’m just going to switch on the machine at this point. But the first thing I will need to do is make sure that I pop the patients details in.

Skip to 0 minutes and 37 seconds So I just need to press the button and allow me to access the Patient ID screen. So as before, it is Mark Collins.

Skip to 0 minutes and 53 seconds And we can pop in your sex as male, as we can pop in your date of birth, which is 24/01/1955. And we’re just doing this as a routine ECG.

Skip to 1 minute and 23 seconds And two features I’ll also check on the machine is to make sure the paper speed is correct. It should be reading 25 millimetres per second. That is the standard paper speed the machine should always be set at, and the voltage criteria should be 10 millimetres per millivolt. And as we can see, the ECG has now actually appeared. So what I will do at this point is again just double check the patient details to make sure they match. And they are correct. And I’ve recorded why I’ve done the ECG. I’ve put on the patient’s date of birth. And I would note on the ECG any variations from the standard positioning i.e. altered limb position because of being an amputee.

Skip to 2 minutes and 16 seconds If the patient actually had a fine tremor such as in Parkinson’s disease, I’d make a note of that on the ECG. And at the time of doing the ECG, if the patient had any symptoms– do you have any chest pain or discomfort? No, I do not. OK. Lovely. I would note any chest pain or chest discomfort or history of palpitations. And it may be relevant for me just to record some vital signs with that to corroborate any complaints of symptomatology from the patient so the person who’s actually going to analyse the ECG will be aware of the context in which the ECG was recorded and how the patient was feeling at that time in relation to their vital signs.

Skip to 2 minutes and 53 seconds So the next thing for me to do is now I’ve checked all the patient’s personal details, all the reasons why I’ve done the ECG is on here. I will need to look for the clarity of the ECG. I want to see that all 12 leads are represented clearly. I’m looking for a nice, crisp baseline with no wandering. I’m also ensuring that there’s no artefact. The final thing is just to mention on the ECG when you’re recording your normal standard 12 lead, you want to make sure your patient’s comfortable, quiet, not talking to reduce any background noise on the ECG, producing artefact or a wandering base line. And there is an option to use a filter button.

Skip to 3 minutes and 31 seconds Now a filter button is not routinely recommended to be used because it can disguise some of the qualities or features of an abnormal ECG. However, in certain circumstances it may be necessary to do. So if you cannot reduce the patient’s shivering for any reason, you can’t get rid of any artefact despite having cleaned the skin, optimised your position, patient comfort, made sure your patient is as warm as they can be, but in circumstances it’s not always possible to reduce all disturbances to a normal ECG. In that case, you could use to filter button. But it’s most important, again, that this is documented clearly, again, for the purposes of interpretation.

Skip to 4 minutes and 18 seconds And the person who’s looking at the ECG and the patient’s clinical situation needs to know that feature’s been deployed. The final thing is if your patient is symptomatic at the time of an ECG, you would not routinely file the ECG straightaway. You would report this to your senior clinician on duty. It’s important they come along, assess the patient with the ECG at the time, and order any additional tests that may be necessary.

Recording the ECG and documentation

In the fourth video of our ‘How to record an ECG’ series, Clinical Simulation Specialist Jasmine Burnett demonstrates how to record and document a standard ECG recording.

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This video is from the free online course:

ECG Assessment: an Introduction for Healthcare Providers

St George's, University of London