15-lead

[Shishkabob]

Anyone else here routinely do 15-leads on cardiac-related patients? If so, is it common at your agency, or are you the only one that does it?


I've started doing 15-leads fairly frequently. It tends to surprise docs when I go "Here's the twelve lead.... and the fifteen"

 

[STXmedic]

I do them when the initial 12 lead leads me to think it necessary, or if the pt is exhibiting ACS and the 12 lead shows nothing. One of my service's medics use it quite frequently. The other service I'm with, half the medics can't even put the 12 lead electrodes on right....

 

[Aidey]

I would, but on the majority of patients the LP 12 lead cables are too short to be able to have everything in the right spot.

 

[325Medic]

New here, hello all. We, as in the squad I work for preforms 15 leads on all suspected M.I.s when we think inferior wall / Rt. vent M.I. is suspected.

325.

 

[TransportJockey]

You're back! Once I'm allowed to do 12 leads (ie: Once I get my red patch) I plan on doing it when suspecting RVI. I was talking with a medic that works at our service and he was showing me all about them.

 

[usalsfyre]

I'm going to confess, I've never done one. Just not something that's been in my toolbox. I've checked V4R frequently since the beginning of my career, except for a couple of years when I didn't have 12 lead EKG available.

Time to do some studying and rectify this.

 

[TomB]

In my opinion, 15-lead ECGs are not required routinely, although I would consider it for select patients.

For example, I see no value in "confirming posterior extension" of an obvious acute inferior STEMI. What difference does it make?

Likewise, in the setting of acute inferior STEMI, particularly when the RCA is suspected as the culprit artery (STE lead III > STE lead II and STD in leads I and aVL) one should presume RV infarction, particularly when the patient is bradycardic or hypotensive.

However, it's certainly reasonable to obtain a right-sided ECG (or at least lead V4R) in those circumstances.

Do I believe that you will "catch" at an acute posterior STEMI when the standard 12-lead ECG is perfectly normal? No, I do not. In fact I have offered $100.00 to anyone who can produce a normal (not just "non-diagnostic" according to conventional STEMI criteria) 12-lead ECG that shows ST-elevation in leads V7-V9 that turns out to be acute STEMI.

The caveat is that I get to use the ECGs for education, magazine articles, digital media, a book, or whatever else I want to use it for. So far I've had no takers, and I'm starting to think such an ECG does not exist.

Every single case of acute posterior STEMI I've seen shows at least a flattening of the ST-segment in the right precordial leads or an increase in the R/S ratio in lead V1 and/or V2.

Would I capture a posterior 12-lead for those patients? Absolutely! Because without an ECG showing ST-elevation there's a risk the patient may languish in a hospital bed in the emergency department and reperfusion may be delayed.

Tom

 

[fast65]

Hmmmm, my instructors have only ever briefly mentioned a 15-lead in the field, I think I'll ask them more about it tomorrow.

 

[medic417]

Hmmmm, my instructors have only ever briefly mentioned a 15-lead in the field, I think I'll ask them more about it tomorrow.

Not hard just move V4 from left side to right side of chest same location so becomes V4R. Move V6 to the back near the spine becomes V9. Move V5 to V8 position under shoulder blade becomes V8. Print out 12 lead and label them with current positions.

It is worth the 30 seconds and $0.30 to do it. While you may have other indications it benefits the patient as you have more evidence to move patient to the care they need. Really worth doing on diabetics where symptoms are not always the typical ones you expect in cardiac.

 

[fast65]

Not hard just move V4 from left side to right side of chest same location so becomes V4R. Move V6 to the back near the spine becomes V9. Move V5 to V8 position under shoulder blade becomes V8. Print out 12 lead and label them with current positions.

It is worth the 30 seconds and $0.30 to do it. While you may have other indications it benefits the patient as you have more evidence to move patient to the care they need. Really worth doing on diabetics where symptoms are not always the typical ones you expect in cardiac.

Huh, not nearly as hard as I expected. I learned something, thanks! B)