We would like to offer a special thanks to the Clinical Department of the Three Rivers Ambulance Authority in Fort Wayne, IN for the use of their training center and equipment in the making of this blog.
WHEN TO CONSIDER A RIGHT-SIDED 12 LEAD
- All patients with inferior STEMI (Elevation in II, III, AvF)
- ST elevation in V1
- ST elevation in lead III is greater than lead II
- If no inferior STEMI is detected, but ST elevation in V1 with depression in V2
If a right sided EKG is warranted, simply place leads V1-V6 as you would on the pt’s left side, except place on the right side. V1 and V2 can be left in place as they are already a mirror image. Pay close attention to lead V4R as its placement is most likely to capture evidence of right ventricular infarction. Make sure to label right sided EKG appropriately. For example: V3R, V4R, V5R, V6R.
HOW TO SET UP A RIGHT-SIDED 12 LEAD
HOW TO LABEL A RIGHT-SIDED 12 LEAD
SPECIAL CONSIDERATIONS OF RIGHT VENTRICULAR INVOLVEMENT
Due to damage done to the right ventricle in this type of infarction, patients may be very susceptible to adverse effects with nitroglycerin administration. If the right ventricle is not working at full capacity, preload is already reduced. Nitroglycerin will further reduce preload by vasodilation. However, it is encouraged that you follow your standing orders and/or contact medical control. Pre-treating the patient with a fluid bonus may be a viable option for potential hypotension.
WHEN TO CONSIDER A 15 LEAD
- A 12 lead EKG has confirmed an inferior STEMI (Leads II, III, AvF)
- A 12 lead EKG has confirmed a lateral STEMI (Leads I, AvL, V5, V6)
- Symptomatic ACS patient with ST depression in leads V1 and V2
Posterior myocardial infarction is associated with 15-20% of STEMI’s. Typically this is seen with inferior or lateral involvement. Posterior MI associated with either inferior or lateral STEMI is much more complicated and exponentially increases likelihood of left ventricular damage and debilitation.
Studies have shown acquiring a 15 lead after the initial 12 lead EKG provided better odds of detection of STEMI before more detrimental side effects were noted in patients. It was also determined a larger pool of patients were selected for thrombolytic therapy than with a 12 lead EKG alone.
At the very least, a 15 lead EKG can determine the extent of possible damage to the myocardium, and it involves simply relocating leads and acquiring another EKG.
HOW TO SET UP A 15-LEAD
HOW TO LABEL A 15-LEAD
We hope that this was helpful, and as always, if you have any comments, tips, or suggestions, leave it in the comment section. Hope you guys have a safe and happy Friday!