AnthonyM83 Posted April 8, 2009 Share Posted April 8, 2009 (edited) In skills lab, we instruct applying an ECG monitor. The textbook, "Prehospital Emergency Care, 8th Ed" by Mistovich (2008) instructs a different configuration than what our EMS system uses. I was hoping someone could explain the logic. Our basic ECG consists of four wires: Right Arm (RA) : White Left Arm (LA) : Black Right Leg (RL) : Green (Grounding) Left Leg (LL) : Red That setup is usually referred to as a 4-lead, though only 3 leads views are seen. For 12-leads, electrodes are placed on limbs exactly as labeled (Left Arm, etc). For basic monitoring, they placed on limbs or chest. NOW... For 3-lead or 4-lead monitor, the textbook instructs: RA: Negative ("usually white"): just under right clavicle at midclavicular LA: Grounding ("usually black, brown, or green"): just under left clavicle at midclavicular, but "it can be placed in other areas on the chest in the 3-lead configuration" (since grounding) RL: ("usually red"): left anterior axillary at about 7th ICS LL: ("often green"): right lower lateral chest wall For each, it includes statement such as "it has RL, on the head of the electrode - indicating 'right leg' placement, even though the head is placed on the lower left lateral chest". It never addresses why. Why would that be the standard...and why would leg electrodes be flipped. I have to assume this is (or used to be) standard in some areas... For 12-lead configuration, it instructs identical placement of limb leads (or manufacturer recommendations). The 12-lead part, I'm going to just say is wrong and limb leads must be placed on limbs. One of their own photographs shows V3 in the wrong location, even though they do explain V1-V6 correctly. For lab tomorrow, I'm going to teach our systems method, but I'd like to have an explanation of why the book explained it that way. Thanks for the help. Edited April 8, 2009 by AnthonyM83 Link to comment Share on other sites More sharing options...
Dustdevil Posted April 8, 2009 Share Posted April 8, 2009 You going senile on us, Anthony? http://www.emtcity.com/index.php?showtopic...imb+leads\ Link to comment Share on other sites More sharing options...
celticcare Posted April 8, 2009 Share Posted April 8, 2009 Probably Typos more than anything, I love the brady books, but they have typos all the way through them, like the pictures of the manual defib sequence, it is all out of sync, you see a picture of them charging the paddles with the phrase "apply adhesive pads to the patients bare chest". White to right, red far from the head, black is smoke above fire and green is the grass below the clouds. Link to comment Share on other sites More sharing options...
tom5706 Posted April 8, 2009 Share Posted April 8, 2009 I remembered it by Salt and Pepper Merry Christmas Link to comment Share on other sites More sharing options...
AnthonyM83 Posted April 8, 2009 Author Share Posted April 8, 2009 You going senile on us, Anthony? http://www.emtcity.com/index.php?showtopic...imb+leads\ LOL I will one day, but not yet. That original question was asking whether it mattered if leads are on chest or arms. That thread combined with some other journal studies explaining the importance of actually placing them on the limbs convinced me they must be placed on limbs. My CURRENT QUESTION is why on earth the text would say to flip the leg leads in left-right direction. It specifically says that the RL electrode stands for Right Leg, even though it is placed on lower left chest. !?!?!? It's basically acknowledging that they're limb leads, acknowledging the monitor instructions and labeling, then telling you to do it differently. WTF? Link to comment Share on other sites More sharing options...
Dustdevil Posted April 8, 2009 Share Posted April 8, 2009 My CURRENT QUESTION is why on earth the text would say to flip the leg leads in left-right direction. It specifically says that the RL electrode stands for Right Leg, even though it is placed on lower left chest. !?!?!? Okay, I thought you just accidentally got confused while posting that and switched them yourself, lol. No, I can't think of any reason why they would switch right and left. Sounds like a typo to me. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted April 8, 2009 Share Posted April 8, 2009 That's gotta be a typo. When I'm only doing a 3 lead I place the limb leads on the torso to cut down on artifact from the patient moving and so that there aren't as many wires in the patient's way. But RA just moves to around right midclavicular, not left. Look at einhoven's triangle, reversing them wouldn't work would it? Actually rereading the quoted material, a typo seems unlikely. I'm at a loss... Gonna go hit my books on this and see what I can come up with. Link to comment Share on other sites More sharing options...
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