How to set up a 12 Lead ECG

Set Up ‘Lead’ refers to the plane of electrical activity viewed by a combination

Anatomical Landmarks Mid- axillary line Angle of Louis 3 rd Intercostal Space 2 nd

Electrode 1 3 rd Intercostal Space Angle of Louis 2 nd Intercostal Space 4

Electrode 1 3 rd Intercostal Space 4 th ICS, Right sternal edge Angle of

Electrode 2 3 rd Intercostal Space Angle of Louis 2 nd Intercostal Space 4

Electrode 2 4 th ICS, Left sternal edge 3 rd Intercostal Space Angle of

Electrode 4 5 th Intercostal space, Mid-clavicular line (appex of heart) 2 nd 3

Electrode 3 Equidistance between electrodes 2 & 4

Anterior axillary line Electrode 5 Mid-axillary line Electrode 6 In same plane as Electrode

Peripheral leads Right lower limb lead Right upper limb electrode Left lower limb lead

Taking the ECG � To get a clear trace the patient needs to remain

What does each lead show � Inferior view of heart: › II, III, a.

Summary � Electrodes 1, 2 , 3 - Traffic lights � Electrodes 4, 5,

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How to set up a 12 Lead ECG Hannah Clancy Autumn SSC – Emergency Medicine Practical Procedures

Set Up ‘Lead’ refers to the plane of electrical activity viewed by a combination of electrodes � There are only 10 electrodes in an ECG but these result in 12 visible leads � Patches of the patient’s chest may need to be shaved so that the electrode can establish good contact � Tights may need to be cut for limb leads � In a fitting/tremoring patient, electrodes may need to be placed closer to the trunk to avoid interference �

Anatomical Landmarks Mid- axillary line Angle of Louis 3 rd Intercostal Space 2 nd Intercostal Space 5 th Intercostal Space 4 th Intercostal Space Mid-clavicular line Anterior axillary line

Electrode 1 3 rd Intercostal Space Angle of Louis 2 nd Intercostal Space 4 th Intercostal Space Right sternal edge

Electrode 1 3 rd Intercostal Space 4 th ICS, Right sternal edge Angle of Louis 2 nd Intercostal Space 4 th Intercostal Space Right sternal egde

Electrode 2 3 rd Intercostal Space Angle of Louis 2 nd Intercostal Space 4 th Intercostal Space Left sternal egde

Electrode 2 4 th ICS, Left sternal edge 3 rd Intercostal Space Angle of Louis 2 nd Intercostal Space 4 th Intercostal Space Left sternal egde

Electrode 4 5 th Intercostal space, Mid-clavicular line (appex of heart) 2 nd 3 rd 4 th 5 th Mid clavicular line

Electrode 3

Electrode 3 Equidistance between electrodes 2 & 4

Anterior axillary line Electrode 5 Mid-axillary line Electrode 6 In same plane as Electrode 4

Electrodes 1 -3 1 2 3

Electrodes 4 -6 4 5 6

Peripheral leads Right lower limb lead Right upper limb electrode Left lower limb lead

Taking the ECG � To get a clear trace the patient needs to remain as still as possible 1. Wait for a full screen of clear, level trace 3. Press ‘Continue’ to print 2. Press ‘ECG’

The ECG

What does each lead show � Inferior view of heart: › II, III, a. VF � � Anterior view of heart: Lateral view of heart: › I, a. VL, V 5 -V 6 › V 1 -V 4

Summary � Electrodes 1, 2 , 3 - Traffic lights � Electrodes 4, 5, 6 - Brown, Black, ‘odd one out’ Purple � R arm, L leg - Traffic Lights � R Leg, ‘Earther’, black

1 2 3 4 5 Summary 6