OBTAINING A 12-LEAD EKG

  •  Limb leads:

    • Left and right shoulders, or anywhere on their arms

    • Leg electrodes anywhere below the waist

  •  Chest leads:

    •  V1: The Angle of Louis is the prominence on the sternum where the manubrium (top third of the sternum), sternal body (bottom two thirds), and the second rib all come together. Locate it by palpating the “bump” on the sternum, then move out along the second rib to the patient’s right. Just below the second rib is the second intercostal space. Move down two more intercostal spaces, and position electrode V1 in the fourth intercostal space, just to the right of the patient’s sternum.

    •  V2: Place an electrode in the fourth intercostal space on the left side of the sternum.

    •  V3: Place after V4, see below.

    •  V4: From V2, move down to the fifth intercostal space on the patient’s left, then move laterally to the mid-clavicular line. V4 goes in the intersection of the fifth intercostal space, and the mid-clavicular line.

    • V3: Halfway between V4 and V2
    • V5: Find the anterior axillary line by locating the crease where the arm joins the chest. Move down that line to a point just lateral to V4.

    • V6: V6 is placed on the midaxillary line, level with V5.
  • If MCP suspects an inferior wall MI, they may ask for V4R. Lead V4R is simply Lead V4 on the patient’s Right side, instead of their left. It provides a better picture of the right side of the heart.Capturing Lead V4R is very simple. Just complete the following steps:

    • Perform a normal 12-Lead EKG
    • Place one additional electrode on the patient’s right side, in the same anatomical location as V4 on the patient’s left.
    • Move the V4 Lead from the left, to the new electrode on the right.
    • Complete another 12-Lead EKG.
    • Label this EKG with the patient’s name, and the time. Label V4 prominently as V4R.
  • Skin preparation

    • Use alcohol preps to prep the skin for monitoring electrodes and for 12-Lead EKGs.

    •  DO NOT use alcohol preps with therapeutic electrodes, such as QuikCombo pads.

    • Shave excess hair.

    • Dry skin.

  •  Primary ways to reduce artifact:
    • Thoroughly prep the skin.

      •  Remove excess hair.
    •  Attach each electrode solidly.

    •  Prevent patient movement.

    • Prevent cable movement.

    • Stop the squad.

    • Eliminate electromagnetic interference (EMI):

      •  Turn off or move away from electrical devices.

      • Do not allow patient cables to touch power cords.

      • Make sure patient cables and electrodes are in good shape.

  •  {Transmit the 12-lead EKG} and call the receiving facility.

 

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