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EKG with 4 Lead

Discussion in 'BLS Discussion' started by Asus466, Jun 18, 2018.

  1. Asus466

    Asus466 Forum Ride Along

    Where should the 4 lead be applied to the patient specifically the leg electrodes. I read it should be placed anywhere on the leg but I was told by my partner it should not be placed on the calf's because the muscle interferes with the process.
  2. DesertMedic66

    DesertMedic66 Forum Troll

    In my experience avoid areas where it would be directly on a bony surface and areas where there is a ton of hair. If the patient isn’t hairy then the calf has been a great place for me.
  3. Peak

    Peak ED/Prehospital Registered Nurse

    Depends on how correct you want to be versus how much you want to reduce artifact from a patient who won't hold still.

    For a 12 lead that we are using to actually assess axis then I tend to use a good meaty part of their forearms and lowelegs, but if they won't hold still I've definitely done shoulders and hips. Tremulous patients and smaller kids tend to fall into the latter.

    For just watching their rhythm (extended transports, critical ED patients, et cetera) I put my 3 lead just proximal to the AC joint and my LL just distal to the ribs halfway between the mid axillary and mid clavicular lines. This minimizes artifact when the patient moves, and for monitors in the hospital works well for the respiratory electrical impedance monitoring.
  4. Jubal

    Jubal Forum Ride Along

    I'm just really learning 12-lead and my experience is limited to ED and one agency... BUT... outside the ed (non-emergent) its all torso.

    I've actually been told NOT to put leads on the legs. A lot seems to depend on transport times, and it's very rare for us to have more than 5-7 minutes on the ambulance. But the medics can still get a clear picture with torso and arm placement. Done STEMIS and tachycardia and CHF on the ambulance. A lot has to do with patient comfort and a solid diagnosis for the ed and what the other is wearing and the emergence of the situation.
  5. hometownmedic5

    hometownmedic5 Forum Asst. Chief

    As long as the leads describe Einthovens Triangle(plus the ground), and aren’t impeded by implanted devices, hair, etc, any placement will be suitable for rate, rhythm, and STEMI interpretation. If you want to start getting into the nuance electrocardiology world, then specific placement becomes imperative, but for the EMS world, its of less importance. I try to remain consistent. If the arm leads go on the chest, the leg leads go on the abdomen and so on. Ive never tried to acquire an ekg with the leads all cattywampus all over the body, but I suspect it might be curious to look at. If you’re a basic reading this, find out what your medic wants and do it that way. You wont score any points arguing with your medic on technique, right wrong or indifferent.

    The people that will consider this heresy are usually the same people that will tell you not to take a blood sugar from a venous sample because of the contextually irrelevant difference in the reading you will get between a capillary sample and a venous sample. They aren’t *wrong*, but there are far more important hills to choose to die on.

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