I'm an EMT-B that just found your blog. My agency allows EMT-Bs to perform 12-leads prehospital, so that doctors and paramedics at the hospital have a printout to look at. Also, if our monitor sees an Acute MI or something critical going on with the heart, we know to hurry it up.
Do you have a 12-lead placement diagram? I've been taught where and so on and so forth, but after reading your blog, I'm betting you'd have a nifty diagram. I'm going to print it out and tuck it in my protocol book for reference.
Here are the diagrams you requested.
You can also download a quick reference card from Physio-Control here.
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Update 12/06/08: This is one of the most frequently visited pages on the Prehospital 12 Lead ECG blog. Since many of you are looking for right sided and posterior lead placement, here are some additional diagrams.
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See also:
ABC of clinical electrocardiography - Acute myocardial infarction - Part 1. BMJ 2002; 324:831-834:
Right sided precordial leads
Posterior leads V7 (posterior axillary line), V8 (midscapular), and V9 (paraspinal)
See also:
Contiguous and reciprocal lead charts
Right ventricular infarction
3 comments:
There is a decent fundamental explanation of electrode placement here, A good fundamental explanation here, http://www.mikecowley.co.uk/leads.htm#anchor764680
And an interesting study here, http://ajcc.aacnjournals.org/cgi/content/abstract/6/6/457
Personally, I take electrode placement seriously. In addition, it is important that serial 12-leads should be shot with the electrodes in the same location and with the patient in the same position be it sitting, supine, semi-fowlers, etc. Why? The anatomy changes based on the patient position. In order to properly compare serial 12-leads, the heart must be in the same location relative to the electrodes.
I am a Respiratory Therapist RRT who does ekg's on off shifts for cardiology. Have done ekgs for around 21 years. Our facility just started a STEMI program with goals for door to cath lab in less than 1 hour. I had 2 my last shift. Both were in cath lab in less than 40 minutes. I have been looking for additional info on ekgs especially r sided, have seen different variations (you have nice charts). I have tried to follow lead placement as exact as possible, however have seen others do leads on top of breast of well endowed females rather than lifting up the mass and placing leads underneath in proper fashion, also have seen v3-v6 all in straight row in 4 inch of chest space without even reaching near the midaxiallary line. Some leave patents upright, i always try to lay as flat as possible, but with some you just can;t get them supine due to pain or body habitus. You try to do the best with what you got and go from there. Thanks for the helpful site.~midnterrt
Love your web page, the diagrams are awesome. I too am an RT with 20+ yrs of experience and in the last 5 yrs have been doing more and more "atypical" lead placement for rule outs. thx for the info.
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