Ecg chest leads position

Table of Contents • • • • • • • • • • • What is the order of placement for the ECG chest leads? Proper 12-Lead ECG Placement ELECTRODE PLACEMENT V1 4th Intercostal space to the right of the sternum V2 4th Intercostal space to the left of the sternum V3 Midway between V2 and V4 V4 5th Intercostal space at the midclavicular line When taking an ECG the position of the first chest lead VI is? Where this space meets the sternum is the position for V1. Go back to the “angle of Louis” and move into the 2nd intercostal space on the left. Move down over the next 2 ribs and you have found the 4th intercostal space. Where on the chest is the first chest lead placed? Precordial Lead Placement To locate the space for V1; locate the sternal notch (Angle of Louis) at the second rib and feel down the sternal border until the fourth intercostal space is found. V1 is placed to the right of the sternal border, and V2 is placed at the left of the sternal border. Where is lead 1 ECG? The Frontal Plane Leads: In picture A above, the negative electrode is on the right arm and the positive electrode is on the left arm. This is lead I. Lead I records electrical difference between the left and right arm electrodes. Which position is the best for the patient when performing a 12 lead ECG? The standard 12-lead ECG is generally performed with the patient lying quietly in the supine position. Care should be taken to ensure that the skin is clean and trimmed of excess hair in the areas in which the lead...

• • Positive QRS complexes (with upright P and T waves) in aVR • Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave) • Absent R-wave progression in the chest leads (dominant S waves throughout) These changes can be reversed by placing the precordial leads in a mirror-image position on the right side of the chest and reversing the left and right arm leads. Chris is an Intensivist and ECMO specialist at the After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, His one great achievement is being the father of three amazing children. On Twitter, he is |

Poster Diagnostic ECG Lead Placement This is an educational poster aimed at reviewing the various ECG lead placement techniques. Furthermore, the poster also covers the steps that must be followed to minimize electrode connection problems and obtain optimal readings. The poster can be downloaded at the end of the page Skin Preparation Determine electrode placement according to one of the configurations shown on this poster. Use the following procedure to ensure good quality ECG data: • To minimize electrode problems, be sure to use the proper type of electrode. Check the expiration date on any pregelled electrode before using it. Also, check for dry cell pads on any pregelled electrodes that have been left out of their foil package. • Shave hair from the electrode site. This improves conductivity, helps hold the electrode to the skin, and makes removal of the electrode easier. • Rub each electrode site thoroughly with alcohol. This removes oil from the skin. • Mark each electrode with a felt-tip pen. This provides an easy way to determine when the epidermis has been sufficiently abraded. • Use an abrasive pad to remove the epidermal skin layer at each electrode site. The epidermal skin layer has been removed when the mark left from the felt-tip pen has been erased. • Place an electrode on each prepared site. CAUTION: • Make sure that the electrode’s conducting elements do not contact with each other or other metal parts. • Make sure that the device is not subject to distur...

ECG Lead Placement is the process of attaching electrodes to the patient’s body in order to measure and record the electrical activity of the heart. EKG readings can also detect previous heart attacks. Correct lead placement can help ensure accurate ECG readings and provide valuable insight into a patient’s heart health. Depending on the type of ECG, the number of leads and their placements can vary. Correct lead placement allows medical professionals to accurately measure the electrical activity of the heart and read and analyze EKG results. Each lead typically measures one particular type of electrical activity for a specific location on the patient’s body. The placement of the leads should be consistent across all ECG’s and can be adjusted as needed to ensure accurate readings. • V1– Fourth intercostal space on the right sternum • V2– Fourth intercostal space at the left sternum • V3– Midway between placement of V2 and V4 • V4– Fifth intercostal space at the midclavicular line • V5– Anterior axillary line on the same horizontal level as V4 • V6– Mid-axillary line on the same horizontal level as V4 and V5

What is Electrocardiogram As a non-invasive yet most valuable diagnostic tool, the 12-lead ECG records the heart's electrical activity as waveforms. When interpreted accurately, an ECG can detect and monitor a host of heart conditions - from arrhythmias to coronary heart disease to electrolyte imbalance. Since the first telecardiogram recorded in 1903, huge strides have been made in the recording and interpretation of ECG. Today, the 12-Lead ECG remains a standard diagnostic tool among paramedics, EMTs, and hospital staff. The 12-Lead ECG A 12-lead ECG paints a complete picture of the heart's electrical activity by recording information through 12 different perspectives. Think of it as 12 different points of view of an object woven together to create a cohesive story - the ECG interpretation. These 12 views are collected by placing electrodes or small, sticky patches on the chest (precordial), wrists, and ankles. These electrodes are connected to a machine that registers the heart's electrical activity. Who Should Have a 12-Lead ECG The main purpose of the 12-lead ECG is to screen patients for possible cardiac ischemia . It helps EMS and hospital staff to quickly identify patients who have STEMI (ST elevation myocardial infarction or in other words, heart attack) and perform appropriate medical intervention based on initial readings. 12-Lead ECG Electrode Placement To measure the heart's electrical activity accurately, proper electrode placement is crucial. In a 12-lead EC...

There are three lead systems that make up the standard ECG: • Standard Limb Leads (Bipolar): I, IlI & III • Augmented Limb Leads (Unipolar): aVR, aVL & aVF • Precordial Leads: V1- V6 The Standard Limb Leads are used to display a graph of the potential difference recorded between two limbs at a time, ergo, they are bipolar. In these leads, one limb carries a positive electrode and the other limb, a negative one. The three limb electrodes, I, II and III form a triangle ( Einthoven’s Equilateral Triangle), at the right arm (RA), left arm (LA) and left leg (LL). The three Standard Limb Leads: Einthoven’s Law explains that Lead II’s complex is equal to the sum of the corresponding complexes in Leads I and III and is given as II = I + III For example, • If you had an ECG in which the Lead I R wave was 7mm tall and the S wave 2mm tall, subtract the S from the R, and you would have 5mm. • On the corresponding complex in Lead III, the R wave measures 1mm and the S has a negative deflection of 16mm. Subtracting the R from the S gives -15mm • In Lead II, using the same method as before, you get a measurement of -10mm Using these measurements with Einthoven’s Law you get • II = 5 + -15 = -10 So these leads are electrically equilateral. The Augmented Limb Leads obtain a graph of the electrical forces as recorded from one limb at a time using a null point with a relative zero potential, thus, they are unipolar. These leads, aVR, aVL and aVF give additional views on a trace by reading po...

Case Discussion Chest lead skin positions 1: V1: 4 th intercostal space, right parasternal V2: 4 th intercostal space, left parasternal V3: midway between V2 and V4 V4: 5 th intercostal space in the nipple line in men (under the breast in women) V5: midway between V4 and V6 V6: midaxillary line on the same horizontal line as V4 (may not be 5 th intercostal space) Remember that the CXR appearance will appear to differ from the above as these are the positions on the skin.

ECG Lead Placement is the process of attaching electrodes to the patient’s body in order to measure and record the electrical activity of the heart. EKG readings can also detect previous heart attacks. Correct lead placement can help ensure accurate ECG readings and provide valuable insight into a patient’s heart health. Depending on the type of ECG, the number of leads and their placements can vary. Correct lead placement allows medical professionals to accurately measure the electrical activity of the heart and read and analyze EKG results. Each lead typically measures one particular type of electrical activity for a specific location on the patient’s body. The placement of the leads should be consistent across all ECG’s and can be adjusted as needed to ensure accurate readings. • V1– Fourth intercostal space on the right sternum • V2– Fourth intercostal space at the left sternum • V3– Midway between placement of V2 and V4 • V4– Fifth intercostal space at the midclavicular line • V5– Anterior axillary line on the same horizontal level as V4 • V6– Mid-axillary line on the same horizontal level as V4 and V5

• • Positive QRS complexes (with upright P and T waves) in aVR • Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave) • Absent R-wave progression in the chest leads (dominant S waves throughout) These changes can be reversed by placing the precordial leads in a mirror-image position on the right side of the chest and reversing the left and right arm leads. Chris is an Intensivist and ECMO specialist at the After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, His one great achievement is being the father of three amazing children. On Twitter, he is |

Case Discussion Chest lead skin positions 1: V1: 4 th intercostal space, right parasternal V2: 4 th intercostal space, left parasternal V3: midway between V2 and V4 V4: 5 th intercostal space in the nipple line in men (under the breast in women) V5: midway between V4 and V6 V6: midaxillary line on the same horizontal line as V4 (may not be 5 th intercostal space) Remember that the CXR appearance will appear to differ from the above as these are the positions on the skin.