NCCT NCET cheat sheet

ECG technicians perform diagnostic ECG recordings and may include Holter, event monitoring, and stress testing under supervision.

Scope includes patient preparation, electrode placement, recording acquisition, artifact recognition, and basic rhythm recognition for reporting.

Technicians do not interpret or diagnose rhythms; they report findings to a physician or supervising clinician.

Patient education about the procedure is within scope; obtaining informed consent is typically the physician's responsibility.

Technicians must recognize life-threatening rhythms (e.g., ventricular fibrillation, asystole) and immediately alert the care team.

Infection control: hand hygiene and cleaning reusable electrodes between patients are standard responsibilities.

Documentation of the procedure, patient response, and any artifacts is a core technician duty.

Technicians must know and follow facility protocols for critical value reporting and escalation.

Standard 12-lead placement: V1 4th intercostal space right sternal border; V2 4th ICS left sternal border; V3 midway between V2 and V4; V4 5th ICS midclavicular line; V5 5th ICS anterior axillary line; V6 5th ICS midaxillary line.

Limb leads: RA right arm, LA left arm, RL right leg, LL left leg; avoid placing limb electrodes on bony prominences or over joints.

Prepare skin by cleaning with alcohol and drying; shave excessive hair if needed to reduce artifact.

Position patient supine or semi-recumbent; ensure limbs are relaxed and supported to minimize muscle artifact.

Apply electrodes firmly; check for expiration date and adequate gel; replace if dried or loose.

For pediatric patients, use appropriate electrode size and consider modified lead placement per protocol.

Document any deviations from standard placement and reason (e.g., amputation, wound).

Standard paper speed is 25 mm/s; standard gain is 10 mm/mV; verify these settings before recording.

Calibration pulse should be 10 mm high and 0.2 s wide (at 25 mm/s) to confirm proper gain and speed.

Common artifacts: baseline wander (respiration/movement), somatic tremor (muscle), AC interference (60 Hz), and poor electrode contact.

Troubleshoot artifact by checking electrode adhesion, skin preparation, cable connections, and patient relaxation.

If AC interference persists, check for nearby electrical equipment and ensure proper grounding.

Record a full 12-lead ECG with at least 10 seconds of rhythm strip (usually lead II) for rhythm analysis.

Label each lead clearly and ensure all leads are visible without overlap; adjust gain if necessary for large voltages.

Perform routine equipment checks and report malfunctions; do not use damaged cables or electrodes.

Normal sinus rhythm: rate 60-100 bpm, regular, P wave before every QRS, PR interval 0.12-0.20 s, QRS <0.12 s.

Sinus bradycardia: rate <60 bpm; sinus tachycardia: rate >100 bpm; both with normal P waves.

Atrial fibrillation: irregularly irregular rhythm, absent P waves, fibrillatory baseline.

Ventricular tachycardia: wide QRS (>0.12 s), rate >100 bpm, often regular; treat as emergency if pulseless.

Ventricular fibrillation: chaotic, irregular waveform with no identifiable QRS; immediate defibrillation required.

Asystole: flat line; confirm lead connection and gain before declaring asystole.

Heart rate calculation: 300 / number of large boxes between R waves; or 1500 / number of small boxes.

Strip labeling must include patient name, date, time, lead, and any symptoms or interventions.

Document all ECG findings objectively, including rate, rhythm, and any abnormalities observed, using standard terminology.

Report critical findings (e.g., new ST elevation, ventricular arrhythmias) immediately to the responsible clinician per protocol.

Use SBAR (Situation, Background, Assessment, Recommendation) for structured communication of changes.

Record patient symptoms (chest pain, palpitations, dyspnea) and vital signs at time of ECG.

Note any interventions (e.g., oxygen, medication) and patient response in the record.

Ensure timely entry of ECG data into the medical record; follow HIPAA and facility confidentiality policies.

Verify patient identification before reporting; include unique identifiers to prevent miscommunication.