Twelvelead ECG

Electrocardiogram monitoring provides continuous information about the heart's electrical activity (see Chapter 8), whereas the benefit of a 12-lead ECG is that it produces 12 'views' of the heart and will record the electrical activity from three dimensions. Additionally, not all heart-related problems can be displayed via a cardiac monitor so a 12-lead ECG is necessary to reveal these. For example, bundle branch blocks or myocardial ischaemia are easier to diagnose with a 12-lead ECG.

The 12-lead ECG can assist in investigating many clinical conditions, including:

• finer points of unstable rhythms and the conduction system;

• acute coronary syndromes (ACS);

• evidence of previous myocardial infarction;

• structural heart damage;

• other conditions such as pulmonary embolus, chronic obstructive pulmonary disease, digoxin toxicity, electrolyte disorders.

Table 12.3 Commonly requested post-resuscitation blood tests.

Test

Reasons for test include

Urea and creatinine • Assist assessment of renal function

• Extent of dehydration

Blood chemistry • Identify abnormalities in potassium, sodium, calcium, etc.

Cardiac enzymes • Identifying extent of cardiac muscle damage

• Determining risk of ischaemic damage

Serum glucose • Important to maintain at normal levels Full blood count • Identify risk or extent of bleeding

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