How to Place and Acquire a 12-Lead Diagnostic EKG

[Music] hello everybody this is Lauren and miles with best practice medicine today we're going to be demonstrating how to apply and acquire a diagnostic quality 12 lead ECG the first step in acquiring a diagnostic quality 12-lead ECG is the proper position of your patient ideally your patient should be in a supine position however some patients cannot tolerate this if that's the case you can put them in a semi Fowler's position which is acceptable as well for the purposes of today so we can adequately show you the proper chest electrode position we'll be sitting miles up just a little bit higher than we would normally whichever position your patient is in for the EKG just remember to repeat that position for any follow-on repeat EKGs you may acquire the second step to acquire diagnostic quality 12 lead ECG is to expose the area where the electrodes are going to be placed and in this case we're gonna have to remove miles shirt now that the shirts removed we're gonna have to expose his lower limbs so we can place the limb leads so at this point we're ready to place our limb leads now a few things about limb lead placement in the 12-lead there's only a few rules to have to adhere to to obtain a diagnostic quality ECG when placing limb leads number one is you want to make sure that your limb lead is on the limb that it falls between the shoulder and the wrist the other rule about limb leads is you do not want to put them over bony prominences such as the elbow here or over large muscle groups that's just going to increase the amount of artifact so at this point I'm going to identify probably this area right here to place my limb lead at least my left limb lead and I'm going to make sure that my right limb lead I'm going to make it in a symmetrical location so about the same location on the right hand side the same rules apply for the legs below the hip but above the ankle staying away from bony prominences and large muscle groups in this case just due to access to miles legs we go ahead and put them here just above the ankles now that we've identified our limb lead electrode placement sites would you need to select a package of electrodes in this case our electrodes are in date this is at impacts we'll be using all of these for all of our lead placements they are in date so presumably that we do have conductive gel that is not dried out on these which is important the other thing about these Electra these different style from EKG machine that you kg machine these are more for the pre-hospital type of EKG monitors in hospital you might find a tap style it doesn't really matter the style of EKG electrodes placement and acquisition of the 12 line the principles of that remain the same despite the manufacturer now that we've selected our electrodes we're going to turn our attention to proper skin preparation the first thing to consider is the amount of body hair in this case with large amounts of body hair that's going to affect the the adhesion of the electrode and transmission of the signal through the electrode you're going to want to take a razor oftentimes it's a disposable safety razor and remove the hair from the skin the other thing to consider is the the oils left on the skin as well if you take an alcohol pad and rub the area where the electrode is going to adhere that will remove the oils from the skin and in some cases you might have an excessive amount of dead or dry skin that will also affect the the signal acquisition for your 12-lead in this case you're going to grab a 4x4 or gauze and you'll rub the area 10 to 12 strokes to get just a little bit pink and that maneuver will remove the dead skin and improve the quality of your 12 lead ECG so at this point with our skin prep we're ready to apply the limb leads I'll take my electrodes I will open them up I will find the appropriate electrode these are labeled right leg left leg right arm and left arm Square now that we have the limb leads placed we're going to turn our attention and place the chest leads or the precordial leads unlike the limb lead placement the chest leads must be exact so there's quite a few rules to chest lead placement in order to acquire a diagnostic quality 12 lead ECG the first landmark that we need to find in order to place our chest leads is the fourth intercostal space we can do this two ways the first way to do this is to locate the angle of Louie first you're going to find the sternal notch and you're going to feel or palpate about an inch and a half below the sternal notch you'll feel this ridge in the sternum this is the angle of Louie it's the junction of the sternal body and the manubrium this this slight Ridge that you feel in the sternum is at the level of the second rib so immediately to the left or right of this you will feel the actual rib that is the second rib below the second rib you will find the second intercostal space from here we're going to march down feeling each rib in each space all the way down until we find the fourth intercostal space so if this is the second ICS there's the third rib here's the third ICS here's the fourth rib and here is the fourth intercostal space this is where we're going to place at v1 just immediately to the right of the sternum v2 is going to be placed at the same level immediately to the left of the sternum the second method for locating the fourth intercostal space is to palpate the clavicle immediately inferior to the clavicle that rib space that you feel is the first intercostal space so below that feeling for the rib and the similar technique that we did just before that would be the second rib and again below that is the second ricasso space third rib there intercostal space fourth rib and then finally the fourth intercostal space again v1 goes to the right of the sternum and v2 goes immediately to the left of the sternum now that we have placed v1 and v2 we're going to skip v3 and find the landmark for v4 the four lies at the fifth intercostal space midclavicular line so now that we found our fourth intercostal space it's not too difficult to find the fifth you just palpate the fifth rib and the space below that what we're gonna have to do now is to find the clavicle and what we're gonna do is establish the full length of the clavicle and basically split the middle difference so once we find the full length of clavicle we split that difference LEED v4 is gonna be placed at this level fifth intercostal space midclavicular line now that we place LEED v4 we're gonna skip b5 and place lead v6 v6 lies at the level of LEED v4 but it's at the mid-axillary line miles would you go and lift your arm up at this point we're gonna have to estimate where the mid-axillary line is and by the name mid-axillary it's mid axilla so if you locate their axilla and just draw a line directly down this is your mid axillary line so what we're going to do is just march it perpendicular to the mid axillary line and that's where the lead 6v6 is gonna be placed it's important to note when placing v6 that it does not follow the fifth intercostal space you want to be perpendicular to the mid axillary line now that we have place v1 v2 v4 and v6 we need to place V 3 and V 5 because we skip those and this is just a matter of splitting the distance equally between the electrodes that we have plays so the lead v3 goes halfway between v2 and v4 and v5 will be placed halfway between v4 and v6 now that we've placed all of our electrodes on the chest we can locate our chest electrode or precordial electrode wires and then place them on the appropriate electrode in this case in this model they are labeled v1 through v6 you may encounter a situation where these are very short depending on the model and it may pull your electrode out of place if that's the case you're gonna have to probably replace the electrode as it will not stick on the original site or the original electrode won't stick once that happens now with this model I will have to hook up the the precordial wild wire bundle with my four lead wire set now I'm ready to acquire the 12 lead ECG so now that we're ready to acquire the 12 lead ECG I'm going to lay miles anymore supine position here as we had discussed in addition we want his upper lower extremities uncrossed we want them relaxed it's not cause any muscle tremors so if you put your arms down at your side we'll go ahead and relax the shoulders we'll make sure the legs are not crossed if their hands are resting on a metal bed rail we want to make sure that that's not happening also there can be interference from portable electronic devices so if you have phones or anything like that you might want to set them a little farther away from the patient that way it won't affect the quality of your your twelve-week on this model I simply press the 12-lead button and it's gonna acquire the 12 so during this time you want your patient just to remain still don't hold their breath they just need to breathe normal after a few moments after acquiring and analyzing the 12-lead it should print out and there you have a diagnostic quality 12-lead ECG we hope you found this video informative and useful to your clinical practice tune in next time for more from BPM TV and as always thanks for watching hey Lauren what does this mean it's a great question Myles if you want to know more about how to interpret twelve leads go to best practice medicine comm and check into one of our basic or advanced 12-lead ECG courses thanks

Channel: Best Practice Medicine

Views: 335,178

Keywords: Best Practice Medicine, BPM TV, Team Dynamics, High Fidelity Simulation, Emergency Medicine, Emergency Medical Education, Medical Simulation Education, EMT, paramedic, emergency training, EMS, Simulation, CPR, AED, EMT training, EMT classes, EMT school, EMT bozeman, paramedic training, EMT refresher course, EMT licence, emergency classes, EMT recertification, paramedic refresher, national EMT certification, EMS Grand Rounds, EKG, 12-Lead, Electrocardiogram, Electrocardiography

Id: p_eOL7uy40M

Length: 11min 2sec (662 seconds)

Published: Fri Jun 07 2019