Boobs and the 12 lead

1) Ensure privacy. If at home, close blinds, make sure anyone that the pt isnt comfortable possibly seeing her exposed is out of the room
2) Never do a 12 lead in a public place (within reasonon). Load them first and do it in the back.
3) Ask them to lift their breast or use the back of your hand. Explain the procedure to them and why you need to do it. Get their consent


Follow these rules and you should be ok.
 
Thanks for all the tips folks. Some good stuff here. I put some of them into practice today and they work well (especially the not hiking boob up by the nipple one).
 
bigbaldguy said:
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?
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Move the boob be as exact as you can. Diagnosis quality is not possible without anatomically correct electrode placement.
 
bigbaldguy said:
Thanks for all the tips folks. Some good stuff here. I put some of them into practice today and they work well (especially the not hiking boob up by the nipple one).
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Yes that visualization will remain with you for ever. And yes there was a medic fired for the nipple technique.
 
medic417 said:
Yes that visualization will remain with you for ever. And yes there was a medic fired for the nipple technique.
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Ouch...

Sent from LuLu using Tapatalk
 
Whatever you do, don't offer to check for lumps as a complimentary additional service.
 
Don't cup the boob and lift it, use the bottom of your hand and always make sure to explain the procedure before lifting up the shirt.

It is difficult to place V1 and V2 without full bra exposure, unless someone is wearing a tank-top or a low cut dress or what not.

Don't start out by saying, "I've seen many of these in time" or such as that. A simple procedure explanation is all that is needed. If it needs to be done, do it, in an emergency it isn't the time to be modest. You don't want to have to field a question from the doctor about why you didn't do a 12 lead on a chest pain because you were worried about boobies. Also it isn't a good answer to say, "she is only 22 I wasn't worried about a heart attack."
 
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I did a 12 lead on an elderly lady this morning. After lifting her breast with the back of my hand i had my first encounter with boob cheese:sad::glare::wacko:
 
bigbaldguy said:
Cool, sounds like perfect placement is important.

On an unrelated topic, why is the basic in this video carrying a fishing tackle box :)
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That's interesting you say that, because the medics in my area have a kit that pretty much resembles a tackle box for all of their IV supplies and meds...
 
It's all about them bones.

Remember, don't get diverted by the breast, it's the rib cage you need to be thinking about. You can lift the breast too far, sliding the inferior skin superiorly, so when the mammary traction is relaxed the electrode winds up lower than you were planning on. Sometimes that is unavoidable. As far as over the breast, as long as the shortest path to the target placement is through, say, an inch of tissue versus rerouting four inches or more inferiorly, go for the shorter route. Make a note on your tracing that the pt was "buxom" or some such so the kindly ER doc or cardiologist will have that likelihood of diverted placement.

Why not invent a dorsal EKG?

Such a cultural exercise! Reminds me of the recently changed ARC CPR guidance to administer compressions "between the nipples". ..silly people.
 
abckidsmom said:
<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.
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+1. The more awkward you act, the more embarrassing it will be, for both of you. Use the back of your hand, be quick and smooth and don't make a big stink out of it....

.... if you don't make a big deal of it, they won't either.
 
18G said:
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.
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Agreed, there is not a one person in the ER who I have ever seen "Palpating" for landmakrs, after a few times you know where they go by visualizing. Every once in awhile I will get a patient that I am not so sure about, and I will palpate for ribs.
 
I haven't done it but in Europe the standard is to go over top the breasts. What's the difference: big boob or big fat man boob.

Give it a try. If it don't work, flip em out the way and redo it. Have fun and play with them suckers.

P.S. V1 and 2 work great on top of the nipples. It's something to do with the electrical pathways of the mammary gland in women. Try it and tell my what you think.


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I am here: http://maps.google.com/maps?ll=42.412568,-83.170260
 
MotorCity said:
I haven't done it but in Europe the standard is to go over top the breasts. What's the difference: big boob or big fat man boob.

Give it a try. If it don't work, flip em out the way and redo it. Have fun and play with them suckers.

P.S. V1 and 2 work great on top of the nipples. It's something to do with the electrical pathways of the mammary gland in women. Try it and tell my what you think.


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I am here: http://maps.google.com/maps?ll=42.412568,-83.170260
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Yeah, only V1 and V2 don't belong anywhere close to most nipples. I think I will stick with standard placement. Besides, I refuse to be responsible for the patient having to peel an EKG electrode off her nipple.
 
Fish said:
Agreed, there is not a one person in the ER who I have ever seen "Palpating" for landmakrs, after a few times you know where they go by visualizing. Every once in awhile I will get a patient that I am not so sure about, and I will palpate for ribs.
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BOTH OF YOU ARE WRONG.

Palpate every time, unless your patient is so cachetic that you can SEE the intercostal spaces.


This is a DIAGNOSTIC procedure, lead placement is of the utmost importance.

Please don't teach new providers that you can visualize proper placement. Absolutely w r o n g.
 
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