of the following locations, what is the best area to position electrodes?
Guide To 12-Lead ECG Placement
Talk to my EMT partner virtually my biggest pet peeve, and aside from the lack of professionalism in the Ems industry, he'll tell you lot I can't stand up people who do non know or practise proper 12-lead ECG placement. I've been in EMS for 5 years, and I'chiliad sad to say I accept never one time seen someone apply a 12-lead properly. Don't believe me? Merely search "12-atomic number 82 placement" in Google Images after reading this post and you lot'll run into that almost everyone is guilty.
What is an ECG?
An ECG stands for electrocardiogram. It is a tool used to detect a wide range of heart dysrhythmias using waveforms on a monitor. It is used past healthcare providers regularly both in the hospital and by EMS.
Why Is 12-Atomic number 82 ECG Placement Important?
This is a big deal to me because I have on two occasions moved the someone else'due south 12-lead ECG placement and identified a STEMI that was non visible with the original placement. On the flip side, recently I found a huge STEMI and when I got to the main center hospital, the tech took my leads, moved them down, and couldn't see the STEMI.
It's terrible patient care! These patients sit in the ED for hours while they look for their lab work to come back. Only so do they realize they're having a heart attack. A lot of times this could be avoided if the 12-lead was performed properly and the STEMI was identified on the starting time go-around.
It takes literally less than30 seconds to find the correct position for a 12-lead ECG placement! By the way, did you know that if your electrodes are off by ii centimeters that it tin completely skew your EKG morphology?
4-Pb Placement
Earlier nosotros can get to placing our precordial leads, nosotros need to know where our 4-lead goes. E'er heard four-leads referred to as "limb leads"? In that location'due south a reason for that. These leads are not suppose to go anywhere on the trunk. It'south not as large of a bargain if you lot're merely doing a 4-lead, but doing so when you're going to put the precordial leads on will modify the morphology of your EKG.
Limb leads can be placed on any part of the patient'south respective limbs. Just brand sure the leads are symmetrical. For example, don't put one lead on the left shoulder and the other lead on the right forearm. I've heard of one local md that preferred all 4 leads to be placed relatively equal distances distally. For example, if you put leads on the wrists, then leads should also go on the ankles. I haven't found anything to back that, just that'south at least ane professional'southward theory.
The 12-atomic number 82 ECG electrode placement is essential for paramedics and EMTs in both prehospital and hospital setting as incorrect placement tin atomic number 82 to false diagnosis of infarction or negatively alter the EKG.
Proper 12-Lead ECG Placement
Now that nosotros have our 4-leads straight, let's talk most where your precordial leads will become. Everyone slaps them on below the chest and sometimes below the unabridged rib cage. That is completely unacceptable! Below is a bullet point list for each lead, a description of where they go, and the order they should exist applied.
| ELECTRODE | PLACEMENT |
| V1 | 4th Intercostal space to the right of the sternum |
| V2 | 4th Intercostal space to the left of the sternum |
| V3 | Midway between V2 and V4 |
| V4 | fifth Intercostal space at the midclavicular line |
| V5 | Anterior axillary line at the aforementioned level as V4 |
| V6 | Midaxillary line at the same level as V4 and V5 |
| RL | Anywhere in a higher place the correct talocrural joint and below the torso |
| RA | Anywhere between the correct shoulder and the wrist |
| LL | Anywhere higher up the left ankle and below the trunk |
| LA | Anywhere between the left shoulder and the wrist |
Aside from a 12-lead ECG placement, there's something known as a 15-lead placement which includes placing leads V4-V6 on the posterior side of the patient beneath their left scapula (see below). When viewing the EKG strip, V4-V6 on the strip will exist referred to as V-13-15. To clarify, leads will equal: V4=V7, V5=V8, and V6=V9.
Lastly, a right sided 12-lead ECG placement allows you to discover a right sided infarct. At a minimum, atomic number 82 V4 should exist placed on the 5th intercostal, mid-clavicular (exact reverse of the regular left side placement) if an inferior infarct was originally seen in leads Ii, III, and AVF.
These give you more views of the middle and can help inform your handling plans. For example, you never want to give nitroglycerin if y'all see an inferior infarct until subsequently performing a right-sided EKG. You can view these and other helpful diagrams.
Electrode Misplacement
- Upward to 50 percent of cases have V1 and V2 in too high of a location which can mimic an inductive MI and cause T moving ridge inversion. This article explains how to properly notice the intercostal spaces and where to place the electrodes.
- Up to 33 percent of the cases accept the precordial electrodes (V1-V6) lower or laterally misplaced which also leads to misdiagnosis.
12-Atomic number 82 ECG Electrode Placement Explained
One of the most common questions related to 12-lead ECG electrode placement is why in that location are merely 10 electrodes. Information technology'due south very important to empathise what the term "pb" really means. A lead is a view of electrical activity of the heart from a specific angle across the trunk. So, even though you merely take ten leads, you are actually getting 12 views from different angles. Cables and Sensors does a great job explaining more of the morphology, vertical plane, and Einthoven'south Triangle.
Best Practices For 12-Pb ECG Electrode Placement
- Counting intercostals – When counting downward to the 4th intercostal, it's helpful to know that the 1st intercostal space is the space right beneath the clavicle.
- Clean surfaces – For our patients who seem agin to hygiene, information technology's of import to clean the surface of expressionless tissue to go an accurate EKG reading. Taking a iv×iv of gauze and aggressively rubbing the expanse until it is pinkish will practice the trick.
- The chest – Often times, the 5th intercostal space is about nipple line. On a guy, that'south ok, it doesn't have have to be below the breast contrary to pop belief. Only for women with large breasts do we demand to alter our placement and identify the leads in the crest underneath the breast. This is considering at that place is too much tissue to get a articulate reading
- Look at trending –it'due south recommended to go a baseline before giving oxygen or other medication and and so performing multiple EKGs to see whatsoever how the patient is trending.
Reducing Artifact
The heart'due south electrical signal has very piffling output, so it can easily be combined with other signals of identical frequency to create antiquity. It is not uncommon to have some class of artifact for a 12-lead ECG placement but information technology's of import to attempt to lessen whatever interference in order to ensure an accurate EKG. The following are a few guidelines that are very helpful to reduce antiquity while performing EKG'southward.
- Place patient in a supine position if the patient will tolerate.
- Place the patient'southward arms down past their side to relax their shoulders.
- Patient's legs should be uncrossed.
- Electrical devices such as mobile phones should exist away from the patient as these devices may interfere with the machine.
- Dry the pare if information technology is diaphoretic or moist.
- Shave any hair that can interfere with electrode placement.
- Electrode gel should be moist.
- Electrodes should not exist placed over bones and over areas where at that place is a lot of muscle movement.
- Sometimes an abrasive material such equally a wash cloth may need to be used to remove dead skin cells.
- Chris Kaiser makes a good indicate
I hope this was a helpful review and that all of you will take it to "heart". These are things we regularly get over in our ACLS and PALS classes. If you have comments or additions to what we covered, delight let usa know in the comments section below. If y'all're looking for other great guides, check out what we wrote for using waveform capnography in cardiac abort.
Prime Medical Training provides life-saving training taught by real emergency responders. You tin can view our current locations where nosotros have regularly scheduled classes, or asking for us to do on-site training at your location.
Source: https://www.primemedicaltraining.com/12-lead-ecg-placement/
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