The electrocardiogram (ECG) is a ubiquitous,
noninvasive procedure used extensively in diagnostic
cardiology. The purposes of the acquisition
of an ECG are varied, from bedside monitoring to
ambulatory event monitoring. In the emergency department,
the 12-lead ECG is the initial test for the patient
with chest discomfort or any other acute coronary
syndrome (ACS), and it must be obtained within 10
minutes of patient arrival according to established
standards. In the United States, the incidence of a new
myocardial infarction (MI) is approximately 610,000
annually, and the recurrence rate of a subsequent MI is
approximately 325,000 per year.1 In this context, the ECG
becomes an invaluable tool for the rapid identification of a
patient undergoing a cardiac event. Subsequently, the
interpretation of an ECG may identify patients who need
to go to the catheterization laboratory for emergent
reperfusion through a percutaneous coronary intervention
(PCI) or, if PCI is unavailable or contraindicated, the
administration of thrombolytics. Considering this degree of
importance, why are nurses not provided adequate training
on accurately obtaining 12-lead ECGs? Many essential
nursing skills have been relegated to “on-the-job” training,
but if the trainer/preceptor never learned proper form, the
trainee is subjected to improper techniques and a vicious
cycle is created. This article will focus exclusively on
properly acquiring a 12-lead ECG in the ED setting for a
patient with cardiovascular symptoms.