I put the M in EMTLife
Are providers actually palpating and counting intercostals when placing electrodes?
Probably when they're first learning correct lead placement, yeah. And probably if they don't do it often enough to have 'at a glance' facility. Don't think that's a problem, is it?Are providers actually palpating and counting intercostals when placing electrodes?
so.... does it really matter? meaning, how important is it to be exactly accurate on the anatomical landmarks?When I first started doing it and when I teach it, yes. I haven’t actually palpated it in a long time nor have I seen any providers at any levels do so.
As long as they are somewhat close I don’t think it would make much of a difference but I could be wrong. My 12-lead skills are very dusty as we don’t do them much on the flight side and all the times I have done it, the patient has already been identified as having a STEMI by the sending facility or EMS. @Aprz might have more input on placement causing changes on the 12-lead.so.... does it really matter? meaning, how important is it to be exactly accurate on the anatomical landmarks?
is it clinically significant if you are an inch or so off, because you are eyeballing it? i remember in medic school, we had one guy be our test dummy (the guy has no hair on his chest at all), so we took a 12 lead using the anatomical marks.... and then we moved the leads a bit. there was little to no visible change in the 12 lead. so we moved them again, with the same results. it was a minor change, barely noticeable, but doubtful if it was clinically significant.
I'm not saying you can stick them anywhere and magically it will work, but if you are the right area (ie, eye balling it), and the leads are in the right sequence and secured to the skin, is it really that critical to get the exact anatomical location correct?
did your partner explain why? the only reason I was told (aside from personal preference) is if the patient has Parkinson's, or is shaking a lot, the torso results in less artifact. Otherwise, they are called limb leads for a reason...My current partner did tell me sometimes he can see a difference for limb leads vs torso with extremely weird Rythms he’s having trouble reading.
#DangerSquigglesBut then again I’m a basic so… squiggly lines lol.
He pretty much explained it as a different view of the heart. But I’ve worked with CCT who preferred torso leads for that reason.did your partner explain why? the only reason I was told (aside from personal preference) is if the patient has Parkinson's, or is shaking a lot, the torso results in less artifact. Otherwise, they are called limb leads for a reason...
can you elaborate as to why?I took Bob Page's 12 lead class recently and now I am terrified to put them on the torso again. :O
the class talked about how limb leads stuck on the torso might avoid some artifact but can cause over-augmentation and exaggerated ST segments, making a 12 lead non-diagnostic. If misplaced, they can also cause issues with axis determination. I know people say "oh, that's not true, they're fine on the torso, that's nonsense" but studies have shown placement is important.can you elaborate as to why?