Raven EMS Education Program ManualCardiac 12-Lead Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Explain the procedure to the patient and family members.
Provide for patient modesty as applicable.
Prepare the monitor.
Place the patient in the recumbent or supine position so he or she is fully relaxed with no muscle tone.
Expose the chest.
Clean the skin to remove dead skin and oils and shave chest hair as necessary for each lead below.
Attach the limb leads to the patient (“smoke above fire, snow above trees”):
LA (black) lead: left arm
RA (white) lead: right arm
RL (green) lead: right leg
LL (red) lead: left leg
Identify the angle of Louis: Find the jugular notch of the sternum and move down approximately 1.5 inches or until a slight horizontal ridge or elevation is felt.
Place
V1 (brown/red) lead: Fourth ICS to the right of the sternum.
Place
V2 (brown/yellow) lead: Fourth ICS to the left of the sternum.
Place
V4 (brown/blue) lead: Fifth ICS at left midclavicular line.
Place
V3 (brown/green) lead: Directly between V2 and V4.
Place
V5 (brown/orange) lead: Level with V4 at left anterior axillary line.
Place
V6 (brown/purple) lead: Level with V5 at left midaxillary line.
Instruct the patient to remain still.
Press the appropriate button to acquire the 12-lead ECG.
Transmit the ECG using local procedures and equipment or ensures ECG interpretation by qualified personnel.
Document the procedure, time, and results on the report form.
Dispose of all equipment properly.
Accepts evaluation and criticism professionally.
Shows willingness to learn/asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Did not explain and reassure the patient to allow informed consent.
Fails to place leads in proper anatomic locations.
Fails to properly position patient.
Fails to properly prep skin.
Fails to ensure timely ECG interpretation by qualified personnel.
