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The Basics of Basic 12 Lead EKG

Proper electrode placement is critical to gathering EKG data from the patient.  If we don't put the electrodes in the right spots, our EKG will look different from the other EKG's of the past or future.  BE SURE YOU GET THIS RIGHT!

We need to review some anatomical landmarks.

You need to know where the midaxillary line and the midclavicular line are.  Show me these lines.  If you already know about these lines, read on...

Let's start with the limb leads. Put the Arm and Leg leads on the appropriate limb. For the arm leads, place the electrode just up from the wrist on the anterior side (the side you palpate the pulse from).  For the leg leads, place them on the medial surface of the lower leg just above the ankles. Avoid bone and very hairy areas.

The Chest Leads must be placed properly!  Placing a chest lead just one intercostal space (ICS) too high or too low will dramatically alter the tracing!

V1 goes just to the right of the sternum at the fourth intercostal space. (Notice in the picture below that you can use the "Angle of Louis" just below the "Manubrial Notch" in the top of the sternum to find the 2nd ICS, 2 down from there is the 4th).

V2 goes just to the left of the sternum at the fourth intercostal space.

V3 goes midway between V2 and V4 (so you'll need to get V4 on first).

V4 goes in the midclavicular line in the 5th intercostal space. This one is important because several other leads are placed relative to this one.

V5 is placed in the anterior axillary line (halfway between the midaxillary and midclavicular lines) at the same level as V4.

V6 will be placed in the midaxillary line at the same level as V4.

V8 is a vegetable juice drink, and also used to describe an automobile engine configuration.  Has nothing to do with EKG lead placement!

Here's your next test question

Which of the following statements is not correct?

A.  You don't have to be exact in placing electrodes, especially the chest leads, since the position doesn't really make any difference in the EKG tracing.

B.  It is important to get the electrodes in the exact position because any deviation in placement (especially chest leads) will make the EKG inaccurate.

C.  EKG electrodes should not be placed over bone or on hairy areas without first removing excessive hair.

D.  The location of the chest leads is most critical.

I am tired, I am weary, I am worn. Take me away from here! (Back to the EMS page).