# Applying a EKG to a female patient



## ironguy321

We we’re discussing EKG placement when someone brought up an interesting point (considering the majority of the class is males) what do we do if we have a female patient? The ER tech said one way, the nurse said another, and our teacher said something different! I wasn’t for pleased with the system after such a mix up, no one would agree with each other but wouldn’t debate it in front of us although you could sense hostility. Even when we asked, they said do what your told. Does this normally happen? What are the protocols for this at other hospitals? Here’s some of the things we were told:

1. Remove all clothing (cut if trauma/remove if A&Ox4) and tell the patient you need to apply the EKG and will be lifting her breast.
2. Same as above with nurse present.
3. Nurse will apply the EKG (due to lifting breast) but you will place the sticky part (sorry forgot the name) to the electrode for her.


----------



## disassociative

If the EKG is needed, it is needed; regardless. This is just like pelvic exams in nursing. We must be discreet. Tell the patient what it is you are going to do, why you are going to do it. 

Do anything you can to maintain the patients privacy(example: shut the ambulance doors before doing such tasks). It is also smart in today's world to have your partner present to witness the electrode placement.


----------



## ASTMedic

1) Have someone present.

2) You have no choice, they need it and you have to do it.

3) If you are talking about 12 lead, tell the pt what is going on, lift the breast with the BACK of your hand and place the stickers.


----------



## Ridryder911

Simple, place a towel or pillow case/ sheet draped over the breast itself and one can place the electrodes appropriately under the breast. Use professionalism, never ever had a problem with it. 

My partner was a little uncomfortable with performing it last night, while the husband watched. I on the other hand did not care, I was there to care for her. 

R/r 911


----------



## ResTech

I have never even given thought to this cause its apart of my job. When I'm caring for a patient, they are all the same in regards to treatment no matter if male or female. So applying electrodes to a females chest isn't any different for me then applying them to a males chest. 

I always say something like,  "I need to put some electrodes on your chest" before I do it and if they object then they can speak up. Its all about professionalism... I view the human body when working as just that... a human body in need of care. 

Unless your doing a 12-lead you really never have to get ne where near the breast. And I think its ridiculous to have to have a female nurse/medic/emt present to apply electrodes!


----------



## Mercy4Angels

well as bls we shouldnt have to worry with ekg's only the medics carry the monitors.....at least here.


----------



## emtteddy33

if the ekg needs to be done then do it 
male or female it must be done 
so lose the shyness do your job and treat your patient
just my 2 cents


----------



## MedikErik

Never really paid much mind to it... make sure the doors are shut, try and have someone back there if you can, but pretty much I go by treat the patient first, worry about the lawsuits second. Never had a patient complain. Got one small joke (something along the lines of "at least you're cute"), but to be honest I find it to rarely be an issue. Just let 'em know what and why you're doing it, and you'll be fine IMO.


----------



## firecoins

Ridryder911 said:


> Simple, place a towel or pillow case/ sheet draped over the breast itself and one can place the electrodes appropriately under the breast. Use professionalism, never ever had a problem with it.
> R/r 911



I like that idea.


----------



## Epi-do

Great suggestion with the towell, Rid!

Like already suggested, I just use the back of my hand to lift the breast for a 12-lead, and I always tell the patient what I am doing.  If the patient is a female, alot of times the guys will ask me to do it if I am there, but not because the guys are uncomfortable with it.  In my experience, if the patient is already upset and stressed out about what is going on, it just seems to put them at ease a little bit if a female is placing the leads.  That being said, the guys I work with don't make a big deal out of it and always keep the patient as covered as possible during placement.


----------



## medic417

ResTech said:


> Unless your doing a 12-lead you really never have to get ne where near the breast.



I politly want to mention auscultation of lung and heart sounds especially of  large breasted women may require the moving of or asking patient to lift the breast.  If you have to move the breast as already mentioned just use the back of the hand.  Take care of business and do not linger.  Remain professional by explaining what you are doing and preserve as much patient dignity as you can.  Remember someday somebody may be treating your grandmother, mother, wife, or daughter, treat your patient the way you want your family treated.


----------



## emt/ff71185

medic417 said:


> I politly want to mention auscultation of lung and heart sounds especially of  large breasted women may require the moving of or asking patient to lift the breast.  If you have to move the breast as already mentioned just use the back of the hand.  Take care of business and do not linger.  Remain professional by explaining what you are doing and preserve as much patient dignity as you can.  Remember someday somebody may be treating your grandmother, mother, wife, or daughter, treat your patient the way you want your family treated.




I really like this last point about treat the way you would want your family to be treated.  I was doing my E.D. clinicals and "walked in" on a patient taking her shirt off for the nurse and her husband was in the room.  I felt ackward because I was only a student so the only business I had being in there was for a BP and some lung sounds.  Ends up the guy was a FF and was also a B.  He basicly made his wife into a trainer for me as he told her I was going to get lung sounds and a BP every 5 minutes.  She was stable and didn't need this but I took the opportunity to knock out some good vitals.  My point is that people don't care about something as frivalous as that when they or there loved one is sick.  They know you are there to do a job and that job is to help.


----------



## So. IL Medic

ironguy321 said:


> We we’re discussing EKG placement when someone brought up an interesting point (considering the majority of the class is males) what do we do if we have a female patient?



Are we talking three or twelve lead? If three - don't worry about being near the breast. Three leads originally were done with leads on the right and left wrist, then the left ankle. So that third lead can easily be placed low on the rib cage nowhere near a breast. If twelve lead, like others have said, tell the patient where the leads will be placed and place the them professionally.


----------



## Laurellea

We may start using cell phones to send electrocardiogram data to the emergency department before the patient arrives at a hospital, so in this case our EMT-B would have to learn 12 lead placement.   We still have to fork out the big bucks to get our Lifepaks switched over to this system.   Just wanted to throw that out there for someone who said BLS didn't need to worry about this thread.   Not every service may get this, but we are looking at it due to some of our long commute times.   We are very rural.


----------



## emt/ff71185

We have the same situation.  They told us that within a year every department in our system has to have this capability so that, depending on the situation, we can have the CATH lab up and ready to go by the time we get to the hospital which will save precious time over the ER doing there own 12 lead and then calling the CATH lab Doctor from home.


----------



## jeepermedic

Ridryder911 said:


> My partner was a little uncomfortable with performing it last night, while the husband watched. I on the other hand did not care, I was there to care for her.
> R/r 911




I like your thought there,  I am kind of the same way I am an ER tech and the people come to the hospital for a reason to be Dx and Treated for an illness or trauma.  they know that in order for us to Dx or to take care of them, some personal space is going to be invaded.  but saying that what happen with an ECG is the least of there worries if they are suffering from an MI, or any other form of cardiac problem.  Even for that matter you think just lifting a breast is bad you should try cathing someone,  that is even more personal then an ECG but in most cases it HAS to be done.  So no worries, do your job correctly with the least amout fondling(lack of better word) and most amount of privicy(spl) and you will be just fine.


----------



## Jason Lundy

*Be professional*

I was a Monitor Tech. for 4 years on a cardiac unit. I was very professional about checking and replacing leads. A few times the female pt. would ask for a female nurse to put the leads on but when your required to do your job you have to be professional about it.


----------



## emtwacker710

where I am EMT-D's help all the time with applying leads and I have had quite a few female pt's and all I can say is have someone else present while you to it, tell the pt. what your going to be doing, and try to lift with the back of your hand so the pt. can't say you were groping or touching her inappropriately...thats all I got for you


----------



## MSDeltaFlt

Yes, be professional.  Explain what you're going to do.  Give them an "out" if you feel it necessary.  Don't dilly dally.  Use the back of your hand to move the breasts.  You can use a towel or a sheet to cover.  Removing the clothing to perform a 12 Lead on a female medical patient is irrelevant.  Size of the breast is irrelevant.  I've been doing 12 Leads for over 16 years and can get accurate 12 Leads on women just as quickly and professionally as I can on men.


----------



## Jon

I delt with this often when I was doing my EMT-P student time. I'd often be tasked to do 12-leads... I'd explain what I was doing in advance and, as has been suggested, I'd use the back of my hand to lift the breast. If you think EKG's are embarrasing... try puting in a Foley cath.

We didn't usually worry about having a wittness... All the rooms are just curtained off, so if the patient said anything in a louder voice, staff would hear it.


----------



## Anomalous

I've never had the issue come up.  I guess if they really refused, I'd have them sign an AMA.  Or...they could get out and walk.


----------



## medic417

Anomalous said:


> I've never had the issue come up.  I guess if they really refused, I'd have them sign an AMA.  Or...they could get out and walk.




If they are only refusing a procedure you do not have the right to refuse further care.  Patients have the right to decide what they allow you or even the doctor to do.  If they refuse a procedure, explain the risks, then treat them to the best of your ability with what they do allow.


----------



## Jon

medic417 said:


> If they are only refusing a procedure you do not have the right to refuse further care.  Patients have the right to decide what they allow you or even the doctor to do.  If they refuse a procedure, explain the risks, then treat them to the best of your ability with what they do allow.


If they refuse, I'd have someone else do it.. I had that happen occasionally during clinicals. I was fine with it.

I remember hearing a story about my old Ambulance Capt (a longtime friend of the family). He was once on a maternity call with a woman as a patient who was a relative of his (Cousin?). THe patient was in labor and at full-term, and was VERY resistant to him doing an exam on her... so he talked his student through the exam... which went fine until they were pulling up to the ED and the (female) student saw the top of the baby's head.... at that point, my friend explained that HE had to take over, and he did.... the patient's concern was more that she didn't want someone she KNEW to examine her like that.... imagine how complex Thanksgiving Dinners have become 

Of course, this was so long ago that the student is now our ambulance captain .


----------

