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dahlio

A Nifty little Rhyme

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Went on a call today to the Diabetic Emergency. As usual, I ask the paramedics what I can do for them. An older medic asked me, oh, can you set up the monitor. I told her, I'm not sure where to place the electrodes. She then told me: White on the Right, Red on the Rib. Smoke before Fire.

Has anyone ever heard this? She seemed like an old time medic. This was also the Lifepak 12 as well, if it makes a difference. This kind of confuses me as you place an electrode on the pt's leg. Thanks in advance for your clarification.

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She then told me: White on the Right, Red on the Rib. Smoke before Fire.

Has anyone ever heard this?

I suppose it was a lot easier in my day, because we only used three wires. If you could remember, "White is Right," then the rest was easy, because obviously black was opposite of white, and that only left one place for the red. She is still using the same technique, but throwing in the whole "smoke before fire" thing. Can't recall if I have ever heard that before or not. Anyhow...

I don't want to get too technical on you, but if you can Google "Einthoven's Triangle," and just read a paragraph on that and see the diagram, it'll help solidify this in your mind, even if it is getting just a little ahead of yourself. What Einthoven's Triangle will show you is exactly where the three leads need to be, like we learned it so many years ago. Once those three necessary leads are down, that only leaves one place for the Green, so there is no question about it. So...

  • * White Is Right = white on right shoulder

* Black is the opposite of white, so it goes on the opposite shoulder

* Black is the "smoke" and red is the "fire," so the fire goes under the smoke = L ribs/leg

* Only place left for green is on the right ribs/leg

  • I fear that may not have made it any clearer for you, but it will after seeing Einthoven's triangle, and after using up a lot of blank sheets of paper diagramming this from memory for a little bit. Then you'll be doing it in your sleep before your next shift.

She seemed like an old time medic.

She may have been. She may have just been taught by an old time medic, which is pretty common, so these things get passed down long after they have outlived their usefulness.

This was also the Lifepak 12 as well, if it makes a difference. This kind of confuses me as you place an electrode on the pt's leg.

The ribs is an old skool thing, from before the days when we had 12 leads in the field. Unfortunately, so many old skool medics are teaching these days that they still teach placement of the "limb leads" on the chest instead of on... oh, I dunno, maybe THE LIMBS? It makes a huge difference, so be aware of that, even if your medic is not.

If all you are doing is monitoring the basic rhythm or rate of somebody in whom there is no suspicion of cardiopathy, placing all four leads on the chest is acceptable. But if you are running a 12 lead or doing any kind of rhythm diagnostics, they must go on the meaty part of the limbs (biceps and calves) in order to get a diagnostic quality tracing.

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When I learned to set up a 5 lead in the hospital, the mnemonic used was "White on right, smoke over fire, clouds over grass, and chocolate is close to the heart."

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When I learned to set up a 5 lead in the hospital, the mnemonic used was "White on right, smoke over fire, clouds over grass, and chocolate is close to the heart."
My fabulous EMT school didn't even go over that...but on my ride-alongs the medic taught me the first part...the last parts usually get left out when I've heard them.

White on Right,

Smoke Over Fire.

Just remember that it applies for the top leads and you then have enough to know where the rest go. I've been trying to do it by memory lately, but when I'm behind the patient or at weird angles, I end up doubting myself and go back to the saying.

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HA HA HA

Even that rhyme can not fix stupid!!!

Admittedly, there have been a few occassions where I said it to myself while facing the patient and guess where I put the white one??

On the right of course, meaning the pt's left shoulder as I am facing him...lol.

I usually catch myself rather quickly but it is always fun to watch others do it too. I have had many a partner and students do the same thing! However, we have yet to not catch our mistake almost instantly but I am sure somewhere in the land of ours, someone has rode it all the way to the ER like that....

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Where the heck are you getting these unmarked wires anyhow? I got a new LP12 a few months ago, and the wires are all marked, so even a colour blind guy can do it. I ran into one LP12 that was purchased in another country, and most other countries use a different colour scheme than the US does. And they weren't marked either, so that took awhile to figure out. :? But I quickly labelled them once I did!

Again, if you check out the Einthoven's Triangle thing, you'll actually understand what you are doing, instead of just trying to memorise. This is a good place in your career to start putting an emphasis on understanding over memorisation. It's easier and longer lasting.

But even with colour codes and labelled leads, I'd be a liar if I said I've never reversed the leads. :oops: If your medic knows wtf she is doing, she will realise it very quickly though, once she looks at the 12 lead. It's pretty obvious.

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Start on right, Salt, Pepper, Ketchup.

White on right, Smoke over fire.

3 lead is easy. 12 lead takes a little more.

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Real quick replies. Thanks a lot guys/gals. You didn't confuse me dust, actually, that really explained it well for me. I'll be starting Paramedic School starting September 2008. Currently taking all of my Pre-Req's now, but I'm sure I'll get the reasoning behind it then. I will however be reading up on Einthoven's Triangle. Now I won't feel completely useless when I ask if the medic needs a hand with anything. Thanks again for the replies!

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