ECG Lead Placement / Electrocardiogram - Clinical Skills - Dr Gill

[Music] [Music] hello and welcome back to the channel my name is dr james gill and today we're going to be looking at the ecg now we've done a demonstration of the ecg before but today we're going to look specifically about where we're placing the limb leads but crucially why and how that enables us to view the heart in 12 different directions or 12 different views which we see on the ecg so what i mean by that is when you look on the ecg trace we split up the ecg into its various regions which allow us to identify inferior problems of the heart septal problems of the heart lateral issues of the heart so with that in mind let's begin our ecg so my name is dr gill and i've been asked to do an ecg of yourself today before we start but please confirm your name and date of birth mickey mouse second 22nd of march 1997 so before we go any further could we just check do you have any problems with your heart thank you so what i'm going to do i'm going to input that information into the ecg but as well as that i need your height if you know it 178 centimeters perfect and your weight superb oh and your age was 24 super right once we've imported the information we need to make sure that we're gelling our hands and if you could please take off your shirt and lie back on the bed it's quite important when you're doing the ecg that you've got uh the machine on a trolley with wheels to it so you can bring it closer to the patient if you find that your leads aren't quite reaching long enough so we're going to start off with our limb leads so we're going to move our chest leads across the patient to start off with we're going to move our leg leads down uh towards the bottom of the patient and we're going to bring our arm leads to the top so let's just move those over there different ecgs will have slightly different electrodes these electrodes you need to apply a slight extension to each before you apply them to the patient because it's a button end to it if you were to apply this afterwards it would be quite uncomfortable for the patient so with your ecg electrodes placed we need to apply them to the patient so in terms of our first uh leads we're going to place uh on the arms so we want to make sure that they're away from any bony prominences and that we're applying them directly over the skin without any crossovers of the arms and legs in terms of going down on the legs we're going to apply them over the inside of the ankle however they're not absolute in terms of the positioning and what i mean by that is as long as your ecg leads are on the limbs and not over bony prominences that is acceptable you'll see certain ecgs for example when we're doing a um an exercise ecg we'll place the leads at the shoulders and over the mid thighs this is order in order to reduce the risk of them coming off once the patient is running on the treadmill in terms of the six uh chest leads the precordial leads we need to find the maneuverable sternal angle this is associated with the second intercostal space directly below it we then need to find the third and the fourth on the right side of the sternal border this is where we're going to place the first electrode and we're going to make sure that if we've got circular ones like this that the electro conductive material is going vertically we're then going to do the same again medulla sterile angle to the second intercostal space third intercostal space fourth intercostal space to place the second electrode we're then going to jump to the fourth electrode and that's going in the mid cavicular line in the fifth intercostal space now the reason why we've taken the fourth electrode at that point is because the third electrode will go again in the fifth intercostal space but between the second and the fourth electrode we're going to do similar again and take the sixth electrode and place it in the mid auxiliary line on the fifth intercostal space and finally we're going to go back to v5 going between the sixth and the fourth lead again in the fifth intercostal space this will then allow us to attach our wiring to our precordial electrodes in order to get a horizontal or transverse view of the heart with our electrodes in place we then want to attach the leads and thankfully these are color-coded when it comes to the limb leads so we're going to put red to the right arm yellow to the left arm green to the left leg and black to the right leg using the nice and simple phrasal mnemonic ride your green bike and these will be applied in a clockwise fashion so in terms of the limb leads as i said we're going to go for red first for ride then yellow for your then green on the left leg we're going to have our black lead that's going to go to the right leg we then want to apply our chest leads which are color coded but are also numbered so we're going to start off with our obviously v1 then we have v2 v3 v4 v5 and v6 so this should hopefully give us a working ecg let's have a look here so with our leads attached we're confirming that we've got a good trace going through and we're making sure that we're happy with the speed headset at 25 millimeters per second once we can see we've got a good trace and nothing here looks untoward by that i mean any evidence that we've got leads the wrong way round then we're going to hit start to record so we're going to get 10 seconds of recording of the ecg and then we're going to look at the file to make sure that there's no issues here so again we're confirming we've got 52 beats a minute there's no obvious abnormalities here now we can see if the automated system has given us a diagnosis here we've got normal sinus rhythm and a normal ecg and i would actually agree with that however it's always best to make sure you interpret these yourself because the machine can be slightly problematic once we've unwired the patient we can allow the patient to remove their electrodes themselves however we're making sure that we're keeping hold of the attachments and binning in medical waste the actual attachment to the chest so if we kind of take off the electrodes and obviously once we've completed their examination we need to thank the patient and make sure that we return their shirt to them so thank you for that any questions to myself after that no thank you well thank you very much for your time well i hope that overview of the ecg was useful for you so you now understand where it is you place in the leads and why some of those lead placements are important such as avoiding any bony prominences but conversely why there are variations between different disciplines for example with sports medicine as said applying leads to the thighs and the shoulders may be done to improve the signals coming through as opposed to if they're on the very edges of the limbs which we might do with the supine patient well if we try to get the patient to run like that we're going to get a very disrupted signal so if you've got any questions about performance of the ecg please drop them down below and then we're going to have a further video to follow up on this exploring the limb leads what they are and how they're important with regards to the regions of the ecg and hopefully you'll join us for that video as we all progress through our knowledge of the ecg together with that mind take care we'll see you in the next one cheerio [Music] [Music] you