ELECTRODEĤth Intercostal space to the right of the sternumĤth Intercostal space to the left of the sternumĥth Intercostal space at the midclavicular lineĪnterior axillary line at the same level as V4 That is completely unacceptable! Below is a bullet point list for each lead, a description of where they go, and the order they should be applied. Everyone slaps them on below the breast and sometimes below the entire rib cage.
Now that we have our 4-leads straight, let’s talk about where your precordial leads will go. The 12-lead ECG electrode placement is essential for paramedics and EMTs in both prehospital and hospital setting as incorrect placement can lead to false diagnosis of infarction or negatively change the EKG. I haven’t found anything to back that, but that’s at least one professional’s theory. For example, if you put leads on the wrists, then leads should also go on the ankles. I’ve heard of one local doctor that preferred all 4 leads to be placed relatively equal distances distally. For example, don’t put one lead on the left shoulder and the other lead on the right forearm. Just make sure the leads are symmetrical. Limb leads can be placed on any part of the patient’s respective limbs. It’s not as big of a deal if you’re only doing a 4-lead, but doing so when you’re going to put the precordial leads on will alter the morphology of your EKG. These leads are not suppose to go anywhere on the torso. Ever heard 4-leads referred to as “limb leads”? There’s a reason for that. It takes literally less than 30 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 2 centimeters that it can completely skew your EKG morphology? 4-Lead Placementīefore we can get to placing our precordial leads, we need to know where our 4-lead goes. A lot of times this could be avoided if the 12-lead was performed properly and the STEMI was identified on the first go-around. Only then do they realize they’re having a heart attack. It’s terrible patient care! These patients sit in the ED for hours while they wait for their lab work to come back. On the flip side, recently I found a huge STEMI and when I got to the main heart hospital, the tech took my leads, moved them down, and couldn’t see the STEMI. This is a big deal to me because I have on two occasions moved the someone else’s 12-lead ECG placement and identified a STEMI that was not visible with the original placement.
It is used by healthcare providers regularly both in the hospital and by EMS. It is a tool used to detect a wide range of heart dysrhythmias using waveforms on a monitor. What is an ECG?Īn ECG stands for electrocardiogram. Don’t believe me? Just search “ 12-lead placement” in Google Images after reading this post and you’ll see that almost everyone is guilty. I’ve been in EMS for 5 years, and I’m sad to say I have never once seen someone apply a 12-lead properly. Talk to my EMT partner about my biggest pet peeve, and aside from the lack of professionalism in the EMS industry, he’ll tell you I can’t stand people who do not know or practice proper 12-lead ECG placement.