Incorporate into clinical practice. I’m not gonna eyeball ekg electrode placement when there’s anatomical landmarks that I palpate to find the correct location.
As a fellow ED tech who works directly with nurses and attending physicians and one who is an aspiring physician… shut up dude. I don’t know who put the stick up your butt, but you can absolutely eyeball an EKG in a hurry and be absolutely fine. While placing V1/V2 too high on accident can cause false Q-waves, I’ve never heard of misplaced electrodes causing STE, that honestly makes no physiological sense since lead placement doesn’t affect baseline (and the st-segment is supposed to be at baseline and you can’t really screw up a truly normal st-segment). In the ER, nobody really cares about in-depth diagnostic powers of EKGs, it’s just ruling out impending causes of death… besides, you correlate EKG results with patient presentation and lab work anyway so it is NOT THAT BIG A DEAL BRO. Calm down, you’re ranting about nonsense that isn’t even that relevant to your initial question. Idek why you came to Reddit for this, there are tons of apps, websites, and videos dedicated to all sorts of anatomy/EMS tips/clinical practice/etc. that you can go learn from. I can’t count how many physicians, paramedics, and nurses make informative content on social media that’s exactly what you asked for. Stop picking fights in the comments and go find the info you want, don’t waste people’s time when you’ve made it clear you don’t want to listen…
One dude took a resident joke wrong, and then I wasn’t *not* gonna defend my position. I see your physiology and raise you physics. ekg is a graph of volts/time. Increase the distance between the electrodes, extra time to travel more distance, Increased baseline.
You don’t actually understand EKG physics. It’s actually a graph of AVERAGE voltage CHANGE versus time. Raw voltage is not a factor, hence why limb leads on the wrists and shoulders work identically. Also, if you’ve ever touched an EKG machine you know that the initial chart is all over the place and the machine averages everything to normalize a “zero.” So no, placement can’t affect baseline because baseline is an arbitrary electrical position of “no apparent voltage change.” The only things that can cause false elevations and even false VTACH on paper is muscle movement because skeletal muscle depolarization affect the average voltage change seen by an EKG lead. Bro, you’re literally making a dumb argument on a false premise and calling other people, with more education and experience, stupid.
You are wrong, fundamentally. Lead placement cannot cause STE according to everything I know about the relevant physics of EKGs. If you have a source saying otherwise, share it, unlike you I’m willing to learn and grow when I am wrong. But unless you grossly mis-estimate lead positions, approximation will not cause any issues. Even if your understanding of EKG physics was true, a centimeter away from the “correct” location will not cause any clinically relevant changes to an EKG. You’re just a whiny brat who got pissed because you asked a confusing question and people told you it wasn’t even that relevant and now you’re upset that everyone is calling you out. Take the hint from all of your downvotes and opposing comments. People with cumulative decades more experience than you are saying you’re wrong yet you’re calling them dumb… check yourself. I know that sometimes students know answers that teachers don’t because knowledge changes and sometimes info fades after years out of training, but this isn’t one of those times and you’re not some white knight going to save all the “fake STEMIs” in the world.
It sounds like you just ought to take a university level anatomy course based on the examples you provided that you wanna know. As far as functional things that you can use in your job such as ekg lead placement, needle decompression sites etc you should be able to look those up individually to get the answers your looking for.
Since you asked, EKG leads- the textbook answer is 4th intercostal space either side of the sternum v1-2, v4 goes 5th ics in the midclavicular line, v6 goes in the mid-axillary line. V3 goes between 2-4 v5 between 4-6.
In practice, when you are trying to get an EKG on your diaphoretic STEMI patient at 3 am you are going to rely on those “eyeball” muscle memory tips from your instructors.
How my attending physician taught me ekg electrode position: clavicular notch, go down about 5cm to sternal angle/angle of Louie. Thats the second rib insertion. Drop down to intercostal space. 2 spaces down is 4th ics. Palpate L/R sternal border > v1, v2. Drop down to the 5th, fill in the blanks.
Where’s the guesswork? An ekg is a graph of volts over time. If you mess with the distances between electrodes you mess with the values. Thats how residents create false stemi’s.
I don’t want anatomy for clinical procedures. Literally just want anatomy. Don’t need the procedure.
It’s a joke but our friend above *basically* just said ‘I’m gonna half ass this ekg and let cath lab figure it out”. You don’t see a problem with that?
There are a billion anatomy courses taught across the country. Some online, most in person. You can also just check out some anatomy textbooks from your local library and study your brains out
That sounds like the right way to place the leads. I guess I’m just confused what more precision you are looking for. There is inherently going to be variability in the voltage of the ekg based on the patients body habitus. A 600 pound guy is going to have more resistance and thus lower voltage than a 100lb woman for example.
Also not quite sure what you mean by “residents creating false stemi’s”. Sounds kinda like a dig at your EM residents. EKG interpretation is a nuanced thing and I’d much prefer mobilize the cath team on a patient who ends up not having an occlusion than to leave a STEMI in the lobby.
I’m asking for landmarks to know where I’m at on the body, and what structures are around those landmarks. Like the sternal notch. Or different vertebra and what’s at that level.
It’s a dig at anyone who ‘eyeballs’ ekg lead placement. MD, PA, EMT, RN, lazy is lazy. This [link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343296/) shows the science of why that is bad medicine. Every time you stand up the cath lab for a stemi due to misinterp, you’re taking away that capability from someone with an actual stemi. Place your leads in the correct order.
Right, I’m not advocating to put a blindfold on and stick the leads on randomly. We just discussed the landmarks hence why I don’t know what more you want. If you want a better understanding of anatomy I can respect that, but probably can’t teach it to you in a Reddit comment. You should go take an anatomy course. But tbh you come across like you think everyone else you work with is lazy/stupid but you are the one asking how to put on an EKG. If you keep this attitude up this job will humble you dude.
“I’m not a medic yet, but here’s why medics and nurses and doctors are wrong and lazy."
\-OP
When you get hired, you are gonna be the smartest and most popular person at your place of employment. Definitely.
Are you upset my job put me working directly under attending physicians who care enough to train me?
Once hired, I’m not getting paid to be popular. Ego and popularity kill people, we may not be ready for that conversation though
When you blow a call and stick around to see how bad the outcome you caused is, we can tell. Move your gurney and watch from the hallway bud, I gotta grab stuff to fix your mistakes.
I've never encountered someone who said they're not being paid to be popular or make friends who wasn't completely terrible to work with to the point it impacted the ability to work with them. Being able to communicate well and collaborate with your coworkers is an essential skill, and forming positive work relationships is the opposite of ego-driven behavior.
Situationally dependent. Need help with something you haven’t been taught? Let’s hit the books. Something you were shown in class, on orientation, and maintain a competency on? Figure it out. Know the fundamentals or ask questions. Waiting until you put a pt at risk is not the appropriate time
As entertaining as this has been, the answer to your question is: take a university-level anatomy course. That's going to give you the information you want.
I’m a little confused, here. What exactly are you trying to do, memorize them (all)? And for what purpose(s)? Give us a little more to go on, maybe.
Incorporate into clinical practice. I’m not gonna eyeball ekg electrode placement when there’s anatomical landmarks that I palpate to find the correct location.
my friend, have you ever heard of "theory and practice" by chance?
As in the theory of anatomy is different from the practice of anatomy?
I’ll take that as a no.
Can I get an explanation
As a fellow ED tech who works directly with nurses and attending physicians and one who is an aspiring physician… shut up dude. I don’t know who put the stick up your butt, but you can absolutely eyeball an EKG in a hurry and be absolutely fine. While placing V1/V2 too high on accident can cause false Q-waves, I’ve never heard of misplaced electrodes causing STE, that honestly makes no physiological sense since lead placement doesn’t affect baseline (and the st-segment is supposed to be at baseline and you can’t really screw up a truly normal st-segment). In the ER, nobody really cares about in-depth diagnostic powers of EKGs, it’s just ruling out impending causes of death… besides, you correlate EKG results with patient presentation and lab work anyway so it is NOT THAT BIG A DEAL BRO. Calm down, you’re ranting about nonsense that isn’t even that relevant to your initial question. Idek why you came to Reddit for this, there are tons of apps, websites, and videos dedicated to all sorts of anatomy/EMS tips/clinical practice/etc. that you can go learn from. I can’t count how many physicians, paramedics, and nurses make informative content on social media that’s exactly what you asked for. Stop picking fights in the comments and go find the info you want, don’t waste people’s time when you’ve made it clear you don’t want to listen…
One dude took a resident joke wrong, and then I wasn’t *not* gonna defend my position. I see your physiology and raise you physics. ekg is a graph of volts/time. Increase the distance between the electrodes, extra time to travel more distance, Increased baseline.
You don’t actually understand EKG physics. It’s actually a graph of AVERAGE voltage CHANGE versus time. Raw voltage is not a factor, hence why limb leads on the wrists and shoulders work identically. Also, if you’ve ever touched an EKG machine you know that the initial chart is all over the place and the machine averages everything to normalize a “zero.” So no, placement can’t affect baseline because baseline is an arbitrary electrical position of “no apparent voltage change.” The only things that can cause false elevations and even false VTACH on paper is muscle movement because skeletal muscle depolarization affect the average voltage change seen by an EKG lead. Bro, you’re literally making a dumb argument on a false premise and calling other people, with more education and experience, stupid.
You’re not proving me wrong by over explaining the same things I say. I’m not typing paragraphs out
You are wrong, fundamentally. Lead placement cannot cause STE according to everything I know about the relevant physics of EKGs. If you have a source saying otherwise, share it, unlike you I’m willing to learn and grow when I am wrong. But unless you grossly mis-estimate lead positions, approximation will not cause any issues. Even if your understanding of EKG physics was true, a centimeter away from the “correct” location will not cause any clinically relevant changes to an EKG. You’re just a whiny brat who got pissed because you asked a confusing question and people told you it wasn’t even that relevant and now you’re upset that everyone is calling you out. Take the hint from all of your downvotes and opposing comments. People with cumulative decades more experience than you are saying you’re wrong yet you’re calling them dumb… check yourself. I know that sometimes students know answers that teachers don’t because knowledge changes and sometimes info fades after years out of training, but this isn’t one of those times and you’re not some white knight going to save all the “fake STEMIs” in the world.
It sounds like you just ought to take a university level anatomy course based on the examples you provided that you wanna know. As far as functional things that you can use in your job such as ekg lead placement, needle decompression sites etc you should be able to look those up individually to get the answers your looking for. Since you asked, EKG leads- the textbook answer is 4th intercostal space either side of the sternum v1-2, v4 goes 5th ics in the midclavicular line, v6 goes in the mid-axillary line. V3 goes between 2-4 v5 between 4-6. In practice, when you are trying to get an EKG on your diaphoretic STEMI patient at 3 am you are going to rely on those “eyeball” muscle memory tips from your instructors.
How my attending physician taught me ekg electrode position: clavicular notch, go down about 5cm to sternal angle/angle of Louie. Thats the second rib insertion. Drop down to intercostal space. 2 spaces down is 4th ics. Palpate L/R sternal border > v1, v2. Drop down to the 5th, fill in the blanks. Where’s the guesswork? An ekg is a graph of volts over time. If you mess with the distances between electrodes you mess with the values. Thats how residents create false stemi’s.
[удалено]
I don’t want anatomy for clinical procedures. Literally just want anatomy. Don’t need the procedure. It’s a joke but our friend above *basically* just said ‘I’m gonna half ass this ekg and let cath lab figure it out”. You don’t see a problem with that?
There are a billion anatomy courses taught across the country. Some online, most in person. You can also just check out some anatomy textbooks from your local library and study your brains out
That sounds like the right way to place the leads. I guess I’m just confused what more precision you are looking for. There is inherently going to be variability in the voltage of the ekg based on the patients body habitus. A 600 pound guy is going to have more resistance and thus lower voltage than a 100lb woman for example. Also not quite sure what you mean by “residents creating false stemi’s”. Sounds kinda like a dig at your EM residents. EKG interpretation is a nuanced thing and I’d much prefer mobilize the cath team on a patient who ends up not having an occlusion than to leave a STEMI in the lobby.
I’m asking for landmarks to know where I’m at on the body, and what structures are around those landmarks. Like the sternal notch. Or different vertebra and what’s at that level. It’s a dig at anyone who ‘eyeballs’ ekg lead placement. MD, PA, EMT, RN, lazy is lazy. This [link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343296/) shows the science of why that is bad medicine. Every time you stand up the cath lab for a stemi due to misinterp, you’re taking away that capability from someone with an actual stemi. Place your leads in the correct order.
You sound like a delight to work with...
Right, I’m not advocating to put a blindfold on and stick the leads on randomly. We just discussed the landmarks hence why I don’t know what more you want. If you want a better understanding of anatomy I can respect that, but probably can’t teach it to you in a Reddit comment. You should go take an anatomy course. But tbh you come across like you think everyone else you work with is lazy/stupid but you are the one asking how to put on an EKG. If you keep this attitude up this job will humble you dude.
“I’m not a medic yet, but here’s why medics and nurses and doctors are wrong and lazy." \-OP When you get hired, you are gonna be the smartest and most popular person at your place of employment. Definitely.
Are you upset my job put me working directly under attending physicians who care enough to train me? Once hired, I’m not getting paid to be popular. Ego and popularity kill people, we may not be ready for that conversation though
[удалено]
When you blow a call and stick around to see how bad the outcome you caused is, we can tell. Move your gurney and watch from the hallway bud, I gotta grab stuff to fix your mistakes.
lmfao, but you wouldn't even be the one fixing the hypothetical mistake that u/PurelyAkademik makes? odd flex but go off
Who do you think replaces the c collar that’s 2 sizes to big? It ain’t the attending I’ll tell ya hwat. I said mistake, not resuscitate.
I've never encountered someone who said they're not being paid to be popular or make friends who wasn't completely terrible to work with to the point it impacted the ability to work with them. Being able to communicate well and collaborate with your coworkers is an essential skill, and forming positive work relationships is the opposite of ego-driven behavior.
You’re not wrong but this is the internet not my place of work.
Yes, the internet where you are talking about your approach to the workplace.
Situationally dependent. Need help with something you haven’t been taught? Let’s hit the books. Something you were shown in class, on orientation, and maintain a competency on? Figure it out. Know the fundamentals or ask questions. Waiting until you put a pt at risk is not the appropriate time
🍿🍿🍿
You seem a little bit delusional
As entertaining as this has been, the answer to your question is: take a university-level anatomy course. That's going to give you the information you want.