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12 lead ecg tips/tricks

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Hello out there I'm wondering what tip/tricks you use to help setup 12 lead ecgs.

Like one of the tips i was taught for the limb leads is smoke over fire (black over red) snow over grass (white over green).

Thank you very much for any tips.

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Get yourself a 12 lead book; I personally recommend something decent like Lippincott's 12 lead ECG book from their nursing series (little brown one) but I hear Tim Phalen has a good one.

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Hello out there I'm wondering what tip/tricks you use to help setup 12 lead ecgs.

Like one of the tips i was taught for the limb leads is smoke over fire (black over red) snow over grass (white over green).

Thank you very much for any tips.

Generally speaking all of the electrode wires are color coded. They are also labeled. RA means Right Arm. LA means Left Arm and so on. Place them in the proper places and you'll get an accurate ECG.

http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/lead_dia.html

V1: right 4th intercostal space

V2: left 4th intercostal space

V3: halfway between V2 and V4

V4: left 5th intercostal space, mid-clavicular line

V5: horizontal to V4, anterior axillary line

V6: horizontal to V5, mid-axillary line

Generally start placing V1 & V2, then V4, then V6. Then you place V3 between V2 and V4 and V5 between V4 and V6.

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What she said!

Seriously, the most common mistakes I see are:

1.) Placing leads V1 and V2 one intercostal space too high on the anterior chest (in some cases even higher)

2.) Placing leads V1 and V2 too far apart (make a "peace sign" with your fingers and you should be able to touch both electrodes)

3.) Placing lead V3 directly under lead V2

4.) Placing lead V4 under the nipple instead of visualizing the midclavicular line

Other common mistakes that aren't related to lead placement are failure to undress the patient from the waist up and leaving a female's bra on. Protect a female's dignity and get her covered up as soon as possible, but don't place leads down the front of a shirt or reach up under a bra. It's absurd. STEMI patients should be completely undressed (similar to trauma) anyway.

Beyond that it's just taking pride in your workmanship. Shave the chest (hopefully for male patients) and use the benzoin tincture. It works! Also, if you're using rectangular electrodes, line up the edges and make it all symmetrical. It helps keep you organized. There's no value in putting some lengthwise, some width-wise, and some diagonal.

Make sure the leads aren't all tangled up. Strand them out individually to minimize artifact. Don't wrap the O2 line, the IV line, the ECG line, and the BP line together. It's a mess, it looks unprofessional, and it's harder to troubleshoot problems.

Be sure the patient isn't holding him/herself up with his/her arms. The muscle tremors will be noted as artifact. The patient should be in a relaxed semi-Fowlers position and breathing normally. You can lay a towel and/or blankets on top once the electrodes are placed to minimize shivering or Parkinsonian tremors.

If you don't settle for imperfection you will almost never have problems with poor data quality (which confounds computerized measurements and interpretations, makes nuanced interpretations more difficult, and harms the credibility of prehospital 12-lead ECG programs).

Good luck!

Tom

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Shave the chest (hopefully for male patients)

Tom just were do you work ?

Bhwaa haa haa

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Tom just were do you work ?

Bhwaa haa haa

So you know to lay off the alcohol when you visit?

Tom

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All the best advise has been laid, also having your monitor in a position that means your leads wont be drooping all over the place and causing gross artifact. Also knowing your monitor, how its calibrated in regards to the limb leads being on the torso or on the actual extremities.

Not settling for second best and looking for quick fixes will lead to disaster in the long run. Misplaced leads could lead to misplaced treatment. Take the time, take the care, maintain dignity, but at the end of the day, in regards to female patient, a moment that they may be disrobed to provide an adequate diagnosis, could mean the difference between life and death and life over property.

Scotty

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Another useful tip is to slightly abrade the skin directly under where you place the electrodes. This is to get off any oils and the superficial layer of dead skin that can cause artifact. In fact, some ECG electrodes come with a little bit of rough plastic or cloth on the back side of the adhesive for this purpose. I just throw some non-sterile 4x4s in my monitor and use them to prior to applying the patches. Also remember that the electrodes are meant to stay in their packaging until use. As soon as you open them, the gel begins to dry out and becomes less effective as time wears on.

As far as lead placement, I think that was already covered quite well.

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http://ems12lead.blogspot.com/ this is an excellent resource for 12-leads.

Best advice I can give is strive for perfection every single time, sounds stupid eh? Do the utmost to have perfect data quality, even if it means taking an extra moment or two to replace a 'dot' if one of the leads has a wandering baseline. I also do my best to use fresh 'dots', this annoys some partners who don't like it when I take an extra few seconds to open a new pack.

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