CanadiEM Frontline Primer

CanadiEM Frontline Primer – Monitor Leads & ECGs

In Medical Concepts by Teresa ChanLeave a Comment

ECG Illustrations adapted with permission from the LIFTL.com site

Attaching Monitor Leads

It’s probably been a while since you attached cardiac monitor leads. Here is a quick rhyme to help you remember!

  1. White on right (Put the white lead on your patient’s right arm [RA].)
  2. Smoke over fire (On left side of the patient’s body, black lead goes to left arm [LA], red lead goes below on left leg {LL].)
  3. Poop comes from the tummy (Brown lead in the middle [V], closest to the abdomen)
  4. Green goes last.(Green lead is placed on the limb where isn’t one yet – right leg. [RL])
5 Lead ECG Monitors
Where to attach the 5-point cardiac monitor leads

Where to Place the 12-leads of an ECG?

  • Remember there are only 10 electrodes required for a 12-lead ECG
  • 4 of these are for the limb leads (same as the monitor leads – so you can use the same rhyme, minus the V-lead part)
  • 6 of these replace the V lead (brown lead) and are the precordial leads
  • **WARNING** PEOPLE TEND TO PLACE THE V1 & V2 LEADS WRONG A LOT
To review, here’s where you place the precordial leads
  • V1: at the 4th intercostal space (ICS), on the right sternal border
  • V2: 4th ICS, along the left sternal border
  • V4: 5th ICS, at the mid-clavicular line
  • V6: 5th ICS, mid-axillary line (same level as V4)
  • V5: 5th ICS, at the anterior axillary line (same level as V4)
  • V3: midway between V2 and V4

We have listed these OUT OF NUMERICAL ORDER as a hint for how you might best place them to space the leads out properly.

The 10 electrodes for a 12-lead ECG
Placement of 10 electrodes required for a 12-lead ECG.

Recommended Reading, Videos, and Podcasts

The following is part of the CanadiEM Frontline Primer. An introduction to the primer can be found here. To return to the Primer content overview click here.

This post was copyedited and uploaded by Johnny Huang.

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Teresa Chan

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.
Teresa Chan
- 2 hours ago