Guest guest Posted August 25, 2003 Report Share Posted August 25, 2003 , There is a particular school of thought that suggests the optimum placement is on the lateral humerous for the limb leads and the lateral tibia just superior to the ancle. Physiocontrol supports this placement. Their monitors are self-professed diagnostic quality. They say that if the lead placement is not as above that you might as well put one on each butt cheak and one on the forehead. Otherwise its not diagnostic quality. Case and point, when they do a 12 lead in the hospital they put the limb leads on the limbs. The idea, as explained to me, is that the wider the angle on the lead placement the more clearly the view by the machine. It reduces the concentration of electrical current thus reducing interference. Beaumont EMS dictates this placement in their protocols as the appropriate method. Hope I helped. > Hello, > > > My friend and I are debating where the Right and Left ECG/EKG > placement goes. could you help us out? Photos would be great. I say > on the lateral part of the humerus and he says under the clavicle on > the " chest " area... > > Help us out. > > Does it really matter (ECG wise) the placement of them? > > > --- > It won't be the first - heart that you break > It won't be the last - beautiful girl > The one that you wrecked - won't take you back > If you were the last beautiful girl in the world > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2003 Report Share Posted August 30, 2003 In a message dated 8/23/2003 9:41:58 PM Eastern Daylight Time, cafr@... writes: > Hello, > > > My friend and I are debating where the Right and Left ECG/EKG > placement goes. could you help us out? Photos would be great. I say > on the lateral part of the humerus and he says under the > clavicle on > the " chest " area... > > Help us out. > > Does it really matter (ECG wise) the placement of them? > > Actually, placement of the ECG leads has significant impact on the morphology of the ECG image. If you are attempting to evaluate the ECG at a little more diagnostic level, then the leads should be placed as follows: RA - on the right arm in the mid-humerus area. Lateral or anterior are both fine. LA - same, only on the left arm. LL - on the left LEG, as far from the arm leads as possible. This is " diagnostic positioning " . The disadvantage is that it is much more prone to movement artifact (which is why, many moons ago, ICU nurses moved the leads to the chest positions that we [EMS] use now). If you're not worried about diagnostics (e.g., ST elevation, T wave shape, etc.), then put the leads pretty much anywhere. If you're not in dx positioning, the placement really doesn't matter. It kills me to see medics working really hard to get the leads on the clavicles and the left later chest (for the LL lead), thinking that's " where they go " . The chest placement reduces movement artifact ('cause your cx doesn't move as much as your limbs), but it distorts morphology, especially ST & T wave stuff. Hope that helps you, , BS, LP Director Pre-Hospital Services and White Memorial Hospital Temple, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 The placement of the limb leads will change the QRS complex, mostly affecting the amplitude and axis measurements in 3 lead monitoring. Remember that the positive electrode is indicating electricity flowing towards that lead, so if you change the position of that lead, you will change how long and strong that electrical current is flowing towards or away from the positive electrode thus affecting the QRS complex. The bipolar leads of I, II, III, use the LA lead as the negative point for all three settings. For the augmented leads, aVL, aVR and aVF (all unipolar) each of the leads will become positive depending on which augmented lead you are measuring. For the precordial leads V1-V6, only the precordial lead placement is important (it is unipolar). So I suggest that proper lead placement is important at all times, but particularly in DIAG mode. You cannot use a non-diagnostic mode to make ST or T wave determinations anyways, so if you are just monitoring the 3 leads then the exact placement will not be as critical, within reason. So basically, if you are performing a 12 lead then you need to ensure correct lead placement. If you have poor placement techniques in a 3 lead, and you have poor QRS tracings, then correct your lead placement and you may improve your tracing. BTW, the Physio manual says proper lead placement is the inside of both wrists and the inside of both ankles just superior to the bony prominences. Regards Nick ____________________________________________ Nick Nudell, NREMT-P, CCEMT-P California nudell@... " Perception is reality " - Wise Old Paramedic Re: 3 lead placement In a message dated 8/23/2003 9:41:58 PM Eastern Daylight Time, cafr@... writes: > Hello, > > > My friend and I are debating where the Right and Left ECG/EKG > placement goes. could you help us out? Photos would be great. I say > on the lateral part of the humerus and he says under the > clavicle on > the " chest " area... > > Help us out. > > Does it really matter (ECG wise) the placement of them? > > Actually, placement of the ECG leads has significant impact on the morphology of the ECG image. If you are attempting to evaluate the ECG at a little more diagnostic level, then the leads should be placed as follows: RA - on the right arm in the mid-humerus area. Lateral or anterior are both fine. LA - same, only on the left arm. LL - on the left LEG, as far from the arm leads as possible. This is " diagnostic positioning " . The disadvantage is that it is much more prone to movement artifact (which is why, many moons ago, ICU nurses moved the leads to the chest positions that we [EMS] use now). If you're not worried about diagnostics (e.g., ST elevation, T wave shape, etc.), then put the leads pretty much anywhere. If you're not in dx positioning, the placement really doesn't matter. It kills me to see medics working really hard to get the leads on the clavicles and the left later chest (for the LL lead), thinking that's " where they go " . The chest placement reduces movement artifact ('cause your cx doesn't move as much as your limbs), but it distorts morphology, especially ST & T wave stuff. Hope that helps you, , BS, LP Director Pre-Hospital Services and White Memorial Hospital Temple, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 Ditto , and I would add this. If you use the arm and leg placement, you won't have to deal with undies, little old ladies droopy breasts nor, if you're a male attending to a female, run the risk of being accused of fondling. Further, once you have played with lead placement enough you'll know that if you can't tell for sure whether or not there are P waves, you can place electrodes in the Lead or MCL positions and enhance your view of those things. It's also fun, when times are slack in the ER, to put the RA on one person and the LL on another and show the ER folks the strip with two complexes on it. Gene G. In a message dated 8/31/2003 6:37:09 AM Central Daylight Time, DPEMS500@... writes: In a message dated 8/23/2003 9:41:58 PM Eastern Daylight Time, cafr@... writes: > Hello, > > > My friend and I are debating where the Right and Left ECG/EKG > placement goes. could you help us out? Photos would be great. I say > on the lateral part of the humerus and he says under the > clavicle on > the " chest " area... > > Help us out. > > Does it really matter (ECG wise) the placement of them? > > Actually, placement of the ECG leads has significant impact on the morphology of the ECG image. If you are attempting to evaluate the ECG at a little more diagnostic level, then the leads should be placed as follows: RA - on the right arm in the mid-humerus area. Lateral or anterior are both fine. LA - same, only on the left arm. LL - on the left LEG, as far from the arm leads as possible. This is " diagnostic positioning " . The disadvantage is that it is much more prone to movement artifact (which is why, many moons ago, ICU nurses moved the leads to the chest positions that we [EMS] use now). If you're not worried about diagnostics (e.g., ST elevation, T wave shape, etc.), then put the leads pretty much anywhere. If you're not in dx positioning, the placement really doesn't matter. It kills me to see medics working really hard to get the leads on the clavicles and the left later chest (for the LL lead), thinking that's " where they go " . The chest placement reduces movement artifact ('cause your cx doesn't move as much as your limbs), but it distorts morphology, especially ST & T wave stuff. Hope that helps you, , BS, LP Director Pre-Hospital Services and White Memorial Hospital Temple, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 FYO. Originally the leads were placed on the lower arms and lower legs (pre-EMS). Due to artifact with patient movement (eating, patients being given baths) the leads were moved to the chest and abdomen. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2003 Report Share Posted August 31, 2003 When your patient is to diaphoretic, or too furry to allow secure placement of leads on the chest, they may be placed on the wrists and ankles and taped into secure contact......... Not the optimum location, but you can identify problematic rhythms...... And before the mailbox fills up, I do not generally use razors or anti-perspiring in emergent situations......when Chewbaca is having chest pains the razors just hang up in the body hair and waste time.....and what EKG pad is going to stick to the film of wax the antiperspirant leaves? I shave only if pacing is needed.......I will defib with the Zoll by placing the pads, and pressing a folded towel on the anterior pad, like the bad 'ol days when we used paddles. Regards- TD Re: 3 lead placement >Ditto , and I would add this. If you use the arm and leg placement, you >won't have to deal with undies, little old ladies droopy breasts nor, if >you're a male attending to a female, run the risk of being accused of fondling. > >Further, once you have played with lead placement enough you'll know that if >you can't tell for sure whether or not there are P waves, you can place >electrodes in the Lead or MCL positions and enhance your view of those >things. It's also fun, when times are slack in the ER, to put the RA on one person >and the LL on another and show the ER folks the strip with two complexes on >it. > >Gene G. > >In a message dated 8/31/2003 6:37:09 AM Central Daylight Time, >DPEMS500@... writes: >In a message dated 8/23/2003 9:41:58 PM Eastern Daylight Time, >cafr@... writes: > >> Hello, >> >> >> My friend and I are debating where the Right and Left ECG/EKG >> placement goes. could you help us out? Photos would be great. I say >> on the lateral part of the humerus and he says under the >> clavicle on >> the " chest " area... >> >> Help us out. >> >> Does it really matter (ECG wise) the placement of them? >> >> > >Actually, placement of the ECG leads has significant impact on the morphology >of the ECG image. > >If you are attempting to evaluate the ECG at a little more diagnostic level, >then the leads should be placed as follows: > RA - on the right arm in the mid-humerus area. Lateral or anterior are >both fine. > LA - same, only on the left arm. > LL - on the left LEG, as far from the arm leads as possible. > >This is " diagnostic positioning " . The disadvantage is that it is much more >prone to movement artifact (which is why, many moons ago, ICU nurses moved the >leads to the chest positions that we [EMS] use now). > >If you're not worried about diagnostics (e.g., ST elevation, T wave shape, >etc.), then put the leads pretty much anywhere. If you're not in dx >positioning, the placement really doesn't matter. It kills me to see medics working >really hard to get the leads on the clavicles and the left later chest (for the LL >lead), thinking that's " where they go " . The chest placement reduces movement >artifact ('cause your cx doesn't move as much as your limbs), but it distorts >morphology, especially ST & T wave stuff. > >Hope that helps you, > > > > , BS, LP >Director >Pre-Hospital Services > and White Memorial Hospital >Temple, Texas > > > > > Quote Link to comment Share on other sites More sharing options...
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