5 lead ekg placement

[whiteorgo]

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Quick q regarding EKG placement intraop, I never fully understood and was wondering if you can help me.

I know green/white is right, red/black on left. But I heard brown (V) should go to L midaxillary?? but most ppl put it in center of the chest??

And what's the rationale of saying green can be put anywhere? what does it mean that it's a 'ground lead'?, can it really be placed anywhere on the body or anywhere on right side only?

Thanks so much!

 

[pgg]

Quick q regarding EKG placement intraop, I never fully understood and was wondering if you can help me.

I know green/white is right, red/black on left. But I heard brown (V) should go to L midaxillary?? but most ppl put it in center of the chest??

And what's the rationale of saying green can be put anywhere? what does it mean that it's a 'ground lead'?, can it really be placed anywhere on the body or anywhere on right side only?

Thanks so much!

Brown is typically placed left anterior axillary, to measure the lead that would correspond to V5 on a 12 lead. Midaxillary would be closer to V6. Between that and lead II, you should be able to pick up the majority of ischemic events. IIRC the textbook answer is that 90% of cardiac ischemia will be visible in either II or V5. Lead II typically produces the cleanest waveform for assessing rhythm since the p waves are nice and big. V5 is the single best for watching the left ventricle.

People who put the brown lead in the middle of the chest either don't care enough to measure V5 (honestly doesn't matter much in patients who don't have CAD and aren't at risk for ischemia, i.e. most patients having elective surgery), are deliberately measuring V1 or V2 (not very likely), are compromising on lead placement to avoid the surgical field, or they don't know what they're doing.

Green is a ground lead that just reduces artifact. Traditionally placed toward the right leg. I honestly couldn't tell you if it matters at all where it goes, but it might matter some.


Europe uses a different color scheme.

 

[vector2]

I overlap the green lead on the pt's temple so my very important bis sticks extra, extra good

 

[sigrhoillusion]

I overlap the green lead on the pt's temple so my very important bis sticks extra, extra good

I heard that lower BIS scores correlate to higher ST changes in the green lead...

 

[BLADEMDA]

The brown lead is the "V" lead on a typical EKG. This means you can place it on the body to reflect V1-V6. In anesthesia and the operating room we monitor lead V5 for ischemia as PGG posted. I recommend you look at a picture of V-V6 in order to see the property location for that particular V lead.

 

[dhb]

Europe uses a different color scheme.

Red right top, black richt bottom, yellow left top, green left bottom, white ground lead.

 

[Noyac]

Nice summary pgg

 

[BLADEMDA]

1 through 6 represents placement of the V leads (V1-V6). Again, we like to monitor lead II and V5 in the operating room so look at the picture above labeled "5".

 

[No_Pain]

Ground (green lead), by definition, can be placed anywhere (right leg, cardiac apex, forehead...)

 

[sigrhoillusion]

Ground (green lead), by definition, can be placed anywhere (right leg, cardiac apex, forehead...)

EKG pad burns are bad news.

EKG pad burns on genitals are really bad news...

 

[Iso4ane]

I overlap the green lead on the pt's temple so my very important bis sticks extra, extra good

A quick wipe down with a alcohol pad, cleans the grease off most patients.

 

[vector2]

A quick wipe down with a alcohol pad, cleans the grease off most patients.

I was just kidding about the green lead. In actuality I usually just put a big dab of super glue under the bis stickers....works pretty well. In an ideal world I'd be peeling the glue off the patient before he woke up, but it's hard to tell if the patient is awake until my bis reads 100. Once the screen reads that magic 100 and the patient has confirmed the bis readout by bucking violently on the tube, I wait until his hand tries to reach for my hand as I'm ripping the sticker off and then I push 2mg of dilaudid. Patient calms down, I call for PACU vent. Another great anesthetic and another satisfied customer.

 

[sigrhoillusion]

I was just kidding about the green lead. In actuality I usually just put a big dab of super glue under the bis stickers....works pretty well. In an ideal world I'd be peeling the glue off the patient before he woke up, but it's hard to tell if the patient is awake until my bis reads 100. Once the screen reads that magic 100 and the patient has confirmed the bis readout by bucking violently on the tube, I wait until his hand tries to reach for my hand as I'm ripping the sticker off and then I push 2mg of dilaudid. Patient calms down, I call for PACU vent. Another great anesthetic and another satisfied customer.

Where I work it seems like every CRNA and most residents slap a BIS on the patient. It's so disappointing. I had one CRNA put the BIS on a patient we were doing a MAC on... 😵