ECG Placement

so in this video we're going to have a look at ECG placement now firstly what does ECG stand for it stands for electrocardiogram or electrocardiograph and it's a way of measuring the electrical activity of the heart remember that the heart's a pump it's a muscular pump that when it contracts it will push blood either from the atria to the ventricles or from the ventricles out of the respective arteries now before it can contract electrical signals need to be sent down through this muscle tissue and ECGs measure the direction that these waves move okay now what we're going to look at today or very quickly in this video is what we call a 12-lead ECG okay now please be aware that leads are different to electrodes the electrodes are the sticky dots that you place on the patient the leads are basically the set of eyes on the heart having a look at what's going on giving you the ECG readout okay so in a 12-lead ECG we have 12 views of the heart but in actual fact we only only use 10 electrodes to get these 12 years okay so what I'm gonna do now is just show you exactly where these 10 electrodes go and then in the next video you're going to have a look at how these electrodes view the heart differently so all the 10 electrodes you are going to find that four of them go on your limbs one on left hand one on the right hand one left leg one left leg right leg there for electrodes the other six of the 10 electrodes go on the chest and they're called the precordial electrons and they are also the electrodes that give you the precordial leads or precordial readouts so first thing I want to do is draw up the chest so what we're going to do is first of all jewel the stone just very simply and draw the stone we're going to draw the clavicle we're going to draw some ribs maybe six or so ribs one two three four five six okay now when we place these what we call precordial electrons we have six we start at the first one and we call the first one v1 now where does v1 go remember please remember that when you're looking at the patient that's the right side that's the left-hand side and you know that the heart sits upon Stoneham a little bit to the left turned a little bit so the apex or the point of the heart is point once the left hip so you need to keep that in mind because that's important when it comes to the placement of these leads these electrodes okay v1 first electrode we place on the sternum go to the right of that sternum and then count your ribs go to your fourth rib and after that fourth rib is your fourth intercostal space so that's one two three four so to the right of your sternum at the fourth intercostal space one two three four we place the first electrode v1 now v2 is very easy because it goes again at the fourth intercostal space but on the left hand side of the sternum so that's where the v26 now usually you'll skip v3 and I'll show you why in a second move to v4 to find where v4 goes you find the clavicle and go mid clavicular and you'll move down to the fifth intercostal space okay and that fifth intercostal space if you feel should be able to feel your heartbeat well you're actually feeling is the apex of your heart hitting the pre cardian okay that's the fifth intercostal space and that's where you put the four so midclavicular fifth intercostal space before v3 simply goes immediately between v2 and v4 and v5 v6 very easily go and the fifth intercostal space but move towards the axillary the axillary the underarm okay so that means we will also put the five and v6 okay they are the pre-core D electrodes giving you the precordial leads the electrodes you place on the chest of your patient yeah what about the other four because I said there's ten electrodes well if we would have drawn up just the stick figure of an individual you will place one lead or one electrode I should say left arm right arm left leg and right leg now you can see I drew three the same color one a different color now the three of the same color right arm left arm left leg that's important because what you can see is the right leg which are drawing red actually does not contribute to the ECG and regards to it's a view of the heart it's not only does not give us a view of the heart it is a ground for the machine okay so it gets rid of some of that background so what you can see is one two three electrodes right arm left arm left leg they contribute to the views of the heart okay now this is where they're placed now you need to remember that placing them here so if I want to draw the trunk of this individual okay so during the trunk of the individual that placing a lead on a patient's arm is basically the same as placing it at the trunk where that limb connects okay so whether it's here or here or here now the reason why this is important is because we remember we have the heart placed in here roughly and what we have is the left arm lead is going to have its own little view of the heart the right arm lead is going to have its own little view of the heart the left leg lead is going to have its own little view of the heart but in addition to that what you'll find is that unlike the electrodes on the chest these electrodes can speak to each other okay they call it bipolar leads these are called unipolar leads now that means that the right arm can speak to the left arm the right arm can speak to the left leg or left foot and the left arm can spective left foot okay so right arm speaks to left arm right arm speaks to the left leg and left arm it speaks to left leg the reason why this is important is because when they talk to each other they also measure what's going on and regards the electrical activity of the heart in that particular direction okay so in addition to having a view of the heart view of the heart beautiful of the heart from these electrodes we also have a view of the heart basically from this direction because of this one coming across we call that limb lead one where the view of the heart from this direction we call that limb lead 2 and we have one from this direction so this one's going across like this we call that limb lead 3 we don't call this lead because it's a view of the heart to lead down on the electrode we don't call this lead right arm we call it a V which stands for augmented vector right arm don't stress out about that we don't call this one left arm we call it augmented vector left arm and we don't call this left leg and call it a the F which is augmented vector foot so that looks a little bit messy if I were to just draw this up just here just a little bit larger it means that we now have a view of the hive I'm getting rid of this very quickly we have a view of the heart from there from there from there so it's going to be a BL AVR this is going to be a BF we also have a view of the heart from here which is Lindley one a view of the heart from here which is lonely too and a view of the heart from here which is Lindley three how many views of the heart is that that's one two three four five six views of the heart from four electrodes so four electrodes on the limbs give you six views of the heart plus the six views of the heart you get from the pre corner we'll give you 12 legs that's your 12 lead ECG please remember these lands on the chest they're placed on the chest like this so they're viewing the heart from that direction these limb leads are viewing the heart from this direction so what do we have we've got a view of the half from here and the view of the half and here we now have a 3d view of what's going on electrically in the heart okay in the next video I'm going to talk about this in a little bit more detail

Channel: Dr Matt & Dr Mike

Views: 101,329

Keywords:

Id: uxKEA3pKE4g

Length: 10min 35sec (635 seconds)

Published: Tue Aug 09 2016