12-Lead ECG Training Device BME 400 University of Wisconsin – Madison December 10, 2008 Team: Cali Roen, Team Leader Amy Weaver, Communicator Laura Bagley, BSAC Anthony Schuler, BWIG Client: Dr. Patricia Padjen UW EMS Outreach Program Manager Advisor: Prof. Tom Yen Dept. of Biomedical Engineering University of Wisconsin – MadisonECG Trainer 2 Table of Contents Problem Statement........................................................................................................................ 4 Background ................................................................................................................................... 4 12 – Lead ECG ........................................................................................................................... 4 Existing Devices.......................................................................................................................... 5 Product Design Specifications...................................................................................................... 6 Design Alternatives ....................................................................................................................... 7 Feedback Circuit......................................................................................................................... 7 LED Markers .............................................................................................................................. 8 Other Preliminary Designs Considered ..................................................................................... 9 Final Design ................................................................................................................................... 9 Safety and Ethical Considerations ............................................................................................ 12 Future Work................................................................................................................................ 12 References.................................................................................................................................... 14 Appendix A: Product Design Specifications............................................................................. 15 Appendix B: Decision Matrix .................................................................................................... 17 Appendix C: Budget .................................................................................................................. 18ECG Trainer 3 Abstract Electrocardiograms (ECG) are used to measure the electrical activity of the heart and diagnose arrhythmias. Currently there is no training mannequin that teaches both 12-lead electrode placement and ECG signal interpretation in one device. The purpose of this project is to develop an adult mannequin that teaches placement of electrodes based on anatomical landmarks and provides the student with feedback about the accuracy of their placement. The same mannequin should also produce a variety of ECG output signals to teach diagnostics using 12 – lead ECG. Our chosen design uses light emitting diodes (LEDs) and fiber optics to mark the correct 12-lead ECG electrode placement. The device also includes a 15-lead ECG electrode placement mode. An ECG signal simulator will be incorporated next semester.ECG Trainer 4 Problem Statement Effective training methods are an important part of using an electrocardiogram (ECG) to accurately diagnose heart arrhythmias. Current methods for training emergency medical services (EMS) personnel to perform ECG recordings use either a mannequin that shows the correct placement of the electrodes or a human to practice on. The mannequins currently in use have visible electrode placement markers. This does not allow students to learn how to place the electrodes anatomically; they only need to match each electrode to a visible snap. The objective of this project is to develop an adult mannequin that can be used for 12 or 15 – lead ECG training and addresses the problems with the current training methods. Students should determine the placement of the electrodes on the chest of the mannequin using anatomical landmarks (i.e. the rib cage) and the mannequin should provide feedback about the accuracy of the placement. The mannequin should also produce a variety of ECG signals to be displayed when the electrodes are placed correctly. Background 12 – Lead ECG An electrocardiogram (ECG) records the electrical activity of the heart and can be used to diagnose the type and location of arrhythmias of the heart (Yanowitz, 2006). The heart has nodes that produce electrical signals. The signal travels through the heart and surrounding tissue. The ECG electrodes measure this signal at select locations. An ECG lead is comprised of two electrodes. A lead is used to determine the electrical activity through a specific area of the heart. A 12 – lead or 15 – lead ECG can be used to more specifically locate the cause of a heart arrhythmia when compared to a standard 3- or 6 - lead ECG.ECG Trainer 5 Ten electrodes are used for a 12 – lead ECG and fourteen electrodes used for a 15 – lead ECG (Yanowitz, 2006). There are four electrodes placed on each of the four limbs. These are the same four electrodes that would be used for a 3 – lead ECG. Two electrodes are placed at the center of the chest at the fourth intercostals on the right and left sternal boarders; these electrodes are labeled V1 and V2 respectively. For a 12- lead ECG, electrodes V3 – V6 are placed on the left chest (figure 1). For a 15 – lead ECG, four additional electrodes are placed on the right chest, mirroring electrodes V3 – V6 on the left chest. Figure 1: 12-lead ECG Electrode Placement V1: Fourth intercostal space to the right of the sternum V2: Fourth intercostal space to the Left of the sternum V3: Directly between leads V2 and V4 V4: Fifth intercostal space at midclavicular line V5: Level with V4 at left anterior axillary line V6: Level with V5 at left midaxillary line (Directly under the midpoint of the armpit) (American College of Cardiology, 2008) Existing Devices There are several existing devices on the market that are currently used to teach students to perform
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