Chris Jones thankyou for taking the time to inform us that you really enjoyed our video. I plan to make a tips and tricks video this year to compliment our existing one. Kind regards Tim Jones
@@Simba______ thank you for your comment. I have viewed the video and my electrode placement- as you know the last 1or 2 mm of the black line on the electrode is the central point so as far as my eyes can tell they were placed on the intercostal spaces/ sternal edge? However every one is entitled to their opinion and I hope you enjoyed the rest of the video. I wish you all the best. Kind regards Tim.
raisins84 thank you for your very positive feedback. I am making another video on ECG tips and tricks later this year- l hope you’ll find that as interesting. Best Wishes, Tim Jones.
Sadly since only myself and a few members of staff in my trust fit BP’s and Tapes compared to the 1350 persons that could potentially perform an ECG I don’t think I could justify asking for the time needed to make such a video.
I was so eager to see the lower limb leads being placed, but you didn't show that part. In fact its the entire reason why I watched the video in the first place. That being said, very thorough video. I learnt so much that i didn't even know that i didn't know.
praveen sreenivasan glad you enjoyed the video. All the very best in your career. I’ve been performing ECG’s for 7 years and still find it fascinating- ECG interpretation is like learning a new language.
This is brilliant, I am a new HCA and finding so many variants done in my department. Surely it makes sense to at least keep it the same for the same patient so the repeat ECG is more reliable for the Emergency Doctor who has to interpret and sign it.
Donna Marks thank you for your kind words about our video. Sadly due to a lack of education and awareness of the national standards you will find various people performing ECG in various ways☹️. However we know that there is ONLY ONE WAY TO PERFORM AN ECG and that’s the S.C.S.T way. If someone for example doesn’t clean the skin and places the arm electrodes straight on the shoulders without first trying the wrists and to relax the patient, make them more comfortable and maybe adjusting the filter to 40 Hz for the second copy you can point them towards this video. All the best and happy ECGing.
Having started my course recently It was recommended that I watch this in preparation. I found this very interesting and have since watched several times since 👍
Literally said the same thing! Hearing that it’s a little different especially when they have a bigger chest, it’s better to see how the EKGs are placed on the tissue!
Please support the hard working cardiac department at the Royal Wolverhampton by liking and sharing this video through social media. Your support will allow them to develop further information videos to provide clear understanding of the various process and treatments the department employs in the care of its clients.
I was watching this without sound, and thought everything I knew was WRONG when you were demonstrating poor placement (~ 9:50). I'm so glad I rewatched with sound lol
Hi Joan. My self and the Hospital Trust would be delighted if you would educate your students using our training video- this is the reason we made the decision to place it on RU-vid. Kind regards Tim.
We were taught in our lectures at Barts and the London SMD that it does not make a difference if the limb electrodes are placed on the torso or on the limbs. Apparently, historically they would be placed on the torso but then it was discovered that there is no different with putting them on the limbs and so for the sake of decency (especially the LL and RL electrode), the limbs are preferentially chosen
Dear Wavedancer171 thank you for commenting on our video. I feel that I should steer you to the excellent educational resources by the S.C.S.T. Firstly the Clinical Guidelines by Consensus, Recording a standard 12 lead Electrocardiogram and Resting 12 Lead ECG Electrode placement and Associated Problems by Prof. Mac farland and Dr. Coleman they are fascinating reading and will hopefully resolve any queries you have about lead/ electrode placement. Kind regards, Tim Jones.
Helen Stone thanks Helen, it proving to more popular than I could’ve ever hoped. At least people will be aware of the correct ECG Guidelines now. I still need to add Sarah to the credits at the end in all fairness. Take care.
Dear Hannah Taft, thank you for your kind words in regards to our video. I hope you have found it educational and easy to follow. Kind regards, Tim Jones.
Andrew Loot you are indeed correct to point out that I touched a Clinical waste bin with my left index finger. As you are aware this is incorrect and I have since amended my clinical practice and we mentioned this point in text at the beginning of the training video. If I’m honest I don’t think I’d ever done that previously or since- it was just a foolish mistake as we were under pressure to conclude filming for the day as the room was needed for clinical purposes. Kind regards Tim Jones.
Hi Tracy, because pre COVID-19 there was no need for me to. The patient was not a barrier patient i.e infectious and myself or the patient did not have broken skin/ dirty skin. Guidelines may differ around the world. Hope this answers your question-stay safe.
Hi Atty, it all depends on how many’s different views or camera angles you want to view the heart from! Some people/ clinicians only require a rhythm ( so a single view will do) or a ED department may require a more detailed picture of the heart so ask for a 12 or even 15 lead ECG.
Could anyone disliking this video by way of a thumb down please be kind enough to at least say why- this could help in the production of any further videos. Many thanks.
I didn't dislike the video but I am learning this procedure and was taught that the patient should be put in the supine position not Fowlers. I'm curious if there is a reason why they suggest that position over the supine? Is it a regional preference thing? My book also states that you don't want the limbs to dangle as it could cause an artifact. I'm curious as to the difference in instruction?
Rachel The Wren Good morning. Thank you for watching my video. The latest SCST ECG Guidelines state that : Patient position Many patients are uncomfortable lying flat, so for consistency and practicality, a semi-recumbent position of approximately 45 degrees is recommended. Any significant variation from this position should be documented on the ECG recording. The limbs should be supported by the bed/couch to minimise artefact due to muscle tension. The ECG appearance can be affected by the angle of incline of the torso at the time of recording. An ECG recorded from a patient in a supine position may vary significantly from one recorded with the patient in an upright position19, 20 or inclined at 60 degrees or greater to the horizontal21. There is no evidence that variation of the inclination of the patient between horizontal and 45 degrees to the horizontal has any significant effect on the ECG. Time should be taken to ensure that the patient is relaxed and comfortable. If these conditions are not satisfied the ECG may record somatic muscle potentials as well as cardiac activity and will make the ECG more difficult to interpret and potentially limit clinical value. Some patients cannot relax fully because of painful conditions such as arthritis, or they may have a condition such as Parkinson’s disease which causes a tremor. These patients should be made as comfortable as possible and the ECG trace annotated with an appropriate explanation if it is suboptimal quality. Before recording the ECG, checks should be made to ensure the patient’s limbs are still and appear relaxed. If the patient has clenched fists or stiff arms or is moving his/her fingers, it will not be possible to obtain a high-quality ECG. In regards to the arm limbs as long as they’re not touching the torso and the electrodes are proximal to the wrists all is well. The guidelines suggest that they are supported by a bed or plinth. I can perform 30 or more ECG’s a morning and have found that hanging the arms off the side of a narrow plinth/ couch drops the patient’s shoulders and nearly always results in a better trace unless the have a tremor/ neck problem etc. Try both positions and use the best for that individual. It’s worth mentioning that when they’re in a hospital bed I don’t usually bother. Hope this has answered your question? I love to know how you get on😊
Jamie Williams thank you for taking the time to let us know how much you enjoyed the video. I wish you all the best in your career. Please watch out for my new video hopefully later this year on ‘tips and tricks for performing an ECG.
katabella I’m so sorry to hear that it was embarrassing for you but by the sounds of it ( if all you upper garments were removed and ribs counted correctly ) the technician performed the test correctly as long as you were covered up immediately once the wires we’re connected. Was your ECG performed like the female in our video?
Don’t be embarrassed, doctors and nurses see people everyday :-) they won’t think anything of it! A phrase which has helped me get through awkward times in life is it’s only embarrassing if you’re embarrassed
We cannot speak for the London Hospitals you mentioned however we can put out this video in the hope it’s contents will be viewed and followed over time through out the UK and further afield. Kind regards, Tim.
Hi Nadia, thank you for your kind words. Unless there is barrier nursing in effect or the patient’s skin is broken gloves are not required as good hand washing technique beforehand is sufficient.
Hi, I did indeed touch the lid of the bin. This was rightfully pointed out to me by many people before the release of the video. If you read the text at the very beginning of this video I acknowledge my mistake and warn against others doing the same. Thank you for your comment. Kind regards Tim.
I wanted the VT ECG to seem to belong to someone that was perceived to be angry or a bit of a tyrant. I just choose Genghis Khan, it could have been one of many characters from history. It was intended to be a bit of fun when I made the video- no offence was or is intended . Kind regards Tim
I think the point was made with the male patient. The females dignity should have been respected; her breast was exposed for training is inapropriate. A maniquin could have been used or verbally explain slight differences and lift breast,
Good morning Traci and thank you for taking the time to comment on our video. The female model who kindly volunteered was a member of our staff that actively performed but also had to interpret ECG in our trust. She felt that it was imperative that this important skill was taught correctly. Sadly using a mannequin to demonstrate this aspect of the video was just not accurate enough. Kind regards Tim.
@@timjones3486 Even if she di volunteer it doesn't make it right to expose her self to prove a point or educate. Respecting herself, viewers, and using discretion is what should have been practiced in a medical procedure.
@@tracitaylor2510 It is clear from this video that the dignity of the female is respected. Firstly, the person cannot be identified from this video. Secondly, permission was given as this was pointed out from Tim's comment. It is very common in healthcare that learners and trainees will be present for medical procedures and testing that are personal and at times rather invasive, however this is always acceptable upon obtaining patient consent so this video is no different. Thirdly, while the instructions were very clear but based from experience, I agree with Tim that using a mannequin is simply insufficient for providing best teaching.
@@tracitaylor2510 Please re-read my previous comment in detail as it clearly addresses your concerns. The reason for the exposure of the breast within a reasonable period of time is purely for educational purposes that are well within ethical, moral, and social standards. And as myself and Tim have pointed. the utilisation of mannequins in itself is inadequate for supporting best teaching regardless of their availability.
Very clear. Easy to understand. I worked as an ECG technician without following a diploma course. A Senior qualified technician he was my employer gave me a training. The information u shared in this video exactly same the way my employer taught me. So i really enjoyed the video.
Hi, I’m so glad that you enjoyed our training video. It’s refreshing to here that your initial training was correct and we thank you for taking the time to leave a comment. Kind regards Tim.
Tim Jones Hi Tim, great video. What’s your explanation as to explain the differences in QRS axis/ R wave amplitudes when moving the limb leads from the standard positions to the torso?
Mark Norris hello. Good question. It is well documented that the closer to the torso the limb electrodes the greater the differences. For example moving the wrist electrodes to towards the torso will increase the r wave amplitude in the inferior leads and decrease it in the hex axial lateral leads. The central terminal is also altered so effecting the precordial amplitude. Finally the cardiac axis will be shift rightwards.
Hi Leo JKM. The person performing the ECG will have to count you rib spaces to make sure an accurate tracing is performed: all upper garments should be removed for this test but every effort should be made to cover you up straight away and keep exposure to a minimum. So unfortunately NO the binder should really be removed. Thank you for asking this important question. Kind regards Tim.
Your room is so nice, it’s not going to be many people around as it’s Covid restrictions! I’m living in Wolverhampton I can pick up my referral form! Hope I will be able to have a lady as I am nervous, anxious and all on my own
Hi, an ECG technician should respect cultural sensitivities/ other requests from male/ female patients. Hopefully a male or female ECG technician will be available on the day of your ECG. If this is not possible a chaperone should made available for the duration of the test. I’m glad you’ve viewed our video so at least you are now aware of how the test will be performed and of the high level of professionalism you should receive. Hope this is of help. Regards Tim
Why does the back of the bed need to be at a 45 degree angle as opposed to lying flat (aside from if they've got chest pain it will help with reducing airway resistance)? Does it affect the ECG reading in any way by having it flat?
Patient position Many patients are uncomfortable lying flat, so for consistency and practicality, a semi-recumbent position of approximately 45 degrees is recommended. Any significant variation from this position should be documented on the ECG recording. The limbs should be supported by the bed/couch to minimise artefact due to muscle tension. The ECG appearance can be affected by the angle of incline of the torso at the time of recording. An ECG recorded from a patient in a supine position may vary significantly from one recorded with the patient in an upright position19, 20 21 or inclined at 60 degrees or greater to the horizontal . There is no evidence that variation of the inclination of the patient between horizontal and 45 degrees to the horizontal has any significant effect on the ECG. Time should be taken to ensure that the patient is relaxed and comfortable. If these conditions are not satisfied the ECG may record somatic muscle potentials as well as cardiac activity and will make the ECG more difficult to interpret and potentially limit clinical value. Some patients cannot relax fully because of painful conditions such as arthritis, or they may have a condition such as Parkinson’s disease which causes a tremor. These patients should be made as comfortable as possible and the ECG trace annotated with an appropriate explanation if it is suboptimal quality. Before recording the ECG, checks should be made to ensure the patient’s limbs are still and appear relaxed. If the patient has clenched fists or stiff arms or is moving his/her fingers, it will not be possible to obtain a high-quality ECG
HI Can you reply soonest please had just recently I think a 12 lead ECG I had a mobile phone in my trouser pocket switched on at the time. Can that have an effect on the test. Thankyou
Mark Newman, I am by no means an expert on this subject and we do ask all patients to either turn off or place mobile phones away from themselves while undergoing an ECG BUT I PERSONALLY haven’t seen any form of interference caused by a mobile phone on any ECG that I’ve performed. I personally as an ECG technician am more concerned about AC ( alternating current) interference from electric beds and other power sources. I’m sure the member of staff would have mentioned to you if there had been problem or interference so I wouldn’t worry if I were you. If you ever have an ECG again or any other hospital test I think it’s always best to turn off your phone to be on the safe side- I do. Hope this has helped, kind regards.
This is something the patient takes lying down. The test gets to the heart of the matter. The technician is sticking to the job with the electrodes. At the end of the test the electrodes are a real rip off and have an uplifting experience and a tear-able experience. They also have a pull up and this has nothing to do with children's diapers. This is also a hair raising experience. This results in sticker shock. Electrode installation is a pressing situation. When the patient gets up from the bed, they change their position on the EKG. The success of the test is down to the wire. When I joke about gel, I'm spreading it pretty thin and the gel is a sticky situation.
Hi, do you mean the V3 electrode? As the V4 is placed in the 5th intercostal space mid clavicular line. V3 electrode however is placed in between V2 and V4 ideally on a diagonal line between the two. If you place V3 too low it will then be be on the same horizontal line as V4, V5 and V6 and would be incorrect.
