11.6 EKG and Cardiovascular Reference Checklist
Key Takeaways
- EKG setup requires identity, explanation, privacy, skin preparation, and accurate lead placement.
- Artifact correction applies to stable patients; symptomatic patients need escalation.
- The CCMA obtains and reports but does not interpret or diagnose.
EKG Reference
EKG questions are high yield because they mix anatomy, patient preparation, equipment troubleshooting, urgent symptoms, and scope. The CCMA verifies the order and patient identity, explains the test, prepares the skin, preserves privacy, places leads accurately, obtains the tracing, and routes it according to policy.
Chest Lead Landmarks
| Lead | Landmark |
|---|---|
| V1 | Fourth intercostal space, right sternal border |
| V2 | Fourth intercostal space, left sternal border |
| V4 | Fifth intercostal space, midclavicular line |
| V3 | Between V2 and V4 |
| V5 | Level with V4 at anterior axillary line |
| V6 | Level with V4 at midaxillary line |
Artifact Table
| Artifact clue | Likely cause | First stable-patient correction |
|---|---|---|
| Wandering baseline | Loose electrode, breathing, motion, poor contact | Reposition, replace electrode, improve contact |
| Somatic tremor | Shivering, anxiety, pain, muscle tension | Warm patient, support limbs, coach stillness |
| AC interference | Electrical source, cable issue, equipment contact | Check wires and nearby equipment |
Red Flag Rule
Chest pressure, radiating pain, severe shortness of breath, syncope, cyanosis, diaphoresis, pallor, severe dizziness, or sudden confusion requires immediate escalation. Do not keep adjusting electrodes while the patient is unstable. Do not tell the patient the tracing is normal or diagnose a cardiac condition.
Exam Cue Table
Use these cues during the last pass through this section. They are designed to make the answer choice obvious when a question mixes several topics at once.
| Cue in the question | Best decision habit |
|---|---|
| Lead placement | Use landmarks, not rough visual placement. |
| Artifact | Troubleshoot only if patient is stable. |
| Cardiac symptoms | Notify provider or activate protocol immediately. |
Last-Minute Self-Test
Cover the right column and explain the decision habit out loud. Then add one example from a practice question you missed. If the example involves a patient identifier, abnormal result, unclear order, privacy issue, failed QC, specimen problem, or urgent symptom, include the exact first action and the exact documentation or reporting step. This is the level of specificity needed for CCMA scenario questions.
Where is V4 placed?
What is a likely cause of somatic tremor artifact?
Which EKG action is outside CCMA scope?