Boobs and the 12 lead

[bigbaldguy]

Ok so I've finally gotten to the point where I can confidently place all the stickies for a 12 lead without having to look at my little cheat sheet. I'm feeling pretty good about myself and maybe even a little cocky. Then on my next call I get a patient with really big breasts and I'm back to square one. All my landmarks are thrown off by the things. So here's my question if I get the stickies put in the wrong spot by an inch or two does it screw up the entire ECG? Is there a margin of error or do I really need to poke around on this poor woman looking for ribs so I can place the stickies in exactly the right spot?

 

[Handsome Robb]

The biggest issue is being over a bone, it messes with the conductivity. If your way off yes it will mess with the reading, just a tid bit wont make a huge difference. I know some people who just toss them on there without palpating. We were doing 12/15 leads today. Get them as close as you can, and remember to use the back of your gloved hand haha

 

[Sasha]

You'll be fine.

But don't be afraid to toss those things out of the way.

 

[abckidsmom]

You must palpate, but how much you have to palpate decreases over time.

 

[bigdogems]

Pretty much as close as you can get. Im sure some doc could tell a small difference but an inch or so off isnt bad. And It will always be a better tracing than if you tried putting it over fat where it should be. Skin prep can also be a huge help

 

[18G]

You dont have to be so precise. Put the electrodes where they are supposed to go and its all good. The electrodes go under the boob so it shouldnt really mess up the land marks.

Just lift it up a little and should be the same as "normal" size boobs.

 

[medicsb]

It can be difficult to get it exact w/ a big breasted individual so there is some guessing to be done.

Some things to remember: don't cup your hand when moving one out of the way and wear gloves if there's even the slightest chance of under-boob-sweat (gross).

 

[medic417]

You dont have to be so precise. Put the electrodes where they are supposed to go and its all good. The electrodes go under the boob so it shouldnt really mess up the land marks.

Just lift it up a little and should be the same as "normal" size boobs.

Lift but not by pulling the nipple. Usually the back of your hand will work but some takes the cup of the palm of your hand. Do not be bashful. Do not hesitate to ask the women to hold them out of the way.

 

[bigbaldguy]

Lift but not by pulling the nipple.

Really! You think someone actually has done that, excuse me ma'am just need to grab hold of your nipple her and sling this over your shoulder? I wonder how hard she hit him.

 

[abckidsmom]

Lift but not by pulling the nipple. Usually the back of your hand will work but some takes the cup of the palm of your hand. Do not be bashful. Do not hesitate to ask the women to hold them out of the way.

<not sure if serious>

Way awkward. Hesitate to ask the woman to hold them out of the way.

"Excuse me ma'am, I'm not able to control your massive breast. Can you give a hand?"

Please hesitate. Just be matter of fact and pretend it's not a big deal. In time, it really will be a non-event.

 

[HotelCo]

<not sure if serious>

Way awkward. Hesitate to ask the woman to hold them out of the way.

"Excuse me ma'am, I'm not able to control your massive breast. Can you give a hand?"

Please hesitate. Just be matter of fact and pretend it's not a big deal. In time, it really will be a non-event.

If that's the case, I just say "We're going to take a better look at your heart, and we have to put some stickers on your chest. Can you lift your left breast, please?"

Easy as pie. No mention of the gargantuan boulders.

 

[Sasha]

Chances are they know their chesticles are larger than normal and are accustomed to having to man handle them themselves and arent shy about it.

Sent from LuLu using Tapatalk

 

[Aidey]

If that's the case, I just say "We're going to take a better look at your heart, and we have to put some stickers on your chest. Can you lift your left breast, please?"

Easy as pie. No mention of the gargantuan boulders.

Exactly. This also gets their arm out of the way so you can place V6.

 

[KingCountyMedic]

Sometimes I have just gone over the top of 'em. There are some things you never want to see under...................

 

[Aidey]

Sometimes I have just gone over the top of 'em. There are some things you never want to see under...................

*facepalm*

To the OP, don't do this. If you think you are off on your landmarks going under the breast tissue, just imagine how far off you can be going on top of it.

 

[MasterIntubator]

Over the years I have learned a few things to make a guy feel more comfortable about.
1 - If the pt is not in a crisis, tell them you would like to do a 12 lead, explain it to them and ask if it would be ok. ( all male crews in my house )
2 - Using the back of your hand to roll the boob works great.
3 - You can place the patches without exposing the boob ( at least nippleage ). Work above and below the bra/shirt. This is great for shopping center calls, etc... anywhere that privacy is tough.
4 - You can have them hold it up to get underneath as well ( works well with the younger female crowd
5 - V4-6 go under the boob, just under the fold at the crease. I lift the boob 1 time and place the leads all at once. Not cool to lift it 3 times ( at least professionally )
6 - V3 does not go over the nipply.
7 - Use your imagination and imagine that the boob in invisible to line up your leads appropriately. You may be off a bit... but ya know... in the field, you will see the big gun waves even though you are off a little. V1,2 and 6 should be easy, V 4 will take the imagination to line up. V3 and 5 should be easy after that
8 - Limit your eyeball time on the chest with the younger crowd... they can tell.
9 - Older folks usually welcome a 12 lead and are far from shy.
10 - Have a some alcohol wipes available for those grande versions that maybe caked with talc powder.
11 - Most importantly.... be professional and give every bit of decency to the pt. Medics have been accused of things due to inappropriate behavior.... even the ones that are not intentional. Why risk it.

My first 30-40 times were a learning experience, and it gets easier and your tactics get better, soon its seconds nature and you no longer go home at night thinking about the experience ( whether good or bad... )

 

[Farmer2DO]

Many good points on here. It gets easier with time.

I still get frustrated by the little old ladies who wear the one piece dresses, where the top button goes all the way down to the start of the manubrium (about an inch below the neck!) and the dress goes below their knees. You have to hike the damn thing up around their ears. Ugh!

 

[medicsb]

*facepalm*

To the OP, don't do this. If you think you are off on your landmarks going under the breast tissue, just imagine how far off you can be going on top of it.

Actually, gravity can have a profound effect on breast tissue and electrode placement may be better if placed over the breast at the points that are over the appropriate anatomic position. You CAN be off if you go under the breast as the breast fold can descend over time. The problem when going over the breast is a possible diminishing of the ECG signal, which is to be weighed against an anatomically INCORRECT placement when going under the breast. Really not that facepalm-worthy.

 

[Sandman-EMT]

It can be difficult to get it exact w/ a big breasted individual so there is some guessing to be done.

Some things to remember: don't cup your hand when moving one out of the way and wear gloves if there's even the slightest chance of under-boob-sweat (gross).

LOL...BOOB-CHEESE!! Thats funny!:rofl:

 

[abckidsmom]

Many good points on here. It gets easier with time.

I still get frustrated by the little old ladies who wear the one piece dresses, where the top button goes all the way down to the start of the manubrium (about an inch below the neck!) and the dress goes below their knees. You have to hike the damn thing up around their ears. Ugh!

I get these ladies in the ambulance (unless we are starting at their home) and undress them into a gown.

Double customer service points right there: the patient gets easier, better care, and the ER nurses think you're fantastic.