2.  ‘Lead’ refers to the plane of electrical activity viewed by a combination of electrodes  There are only 10 electrodes in an ECG but these result in 12 visible leads  Patches of the patient’s chest may need to be shaved so that the electrode can establish good contact  Tights may need to be cut for limb leads  In a fitting/tremoring patient, electrodes may need to be placed closer to the trunk to avoid interference

3. Angle of Louis 2 nd Intercostal Space 3 rd Intercostal Space 4 th Intercostal Space 5 th Intercostal Space Mid-clavicular line Anterior axillary line Mid- axillary line

4. Angle of Louis 2 nd Intercostal Space 3 rd Intercostal Space 4 th Intercostal Space Right sternal edge

5. Angle of Louis 2 nd Intercostal Space 3 rd Intercostal Space 4 th Intercostal Space Right sternal egde 4 th ICS, Right sternal edge

6. Angle of Louis 2 nd Intercostal Space 3 rd Intercostal Space 4 th Intercostal Space Left sternal egde

7. 4 th ICS, Left sternal edge Angle of Louis 2 nd Intercostal Space 3 rd Intercostal Space 4 th Intercostal Space Left sternal egde

8. 5 th Intercostal space, Mid-clavicular line (appex of heart) Mid clavicular line 2 nd 3 rd 4 th 5 th

10. Equidistance between electrodes 2 & 4

11. Anterior axillary line In same plane as Electrode 4 Mid-axillary line

12. 3 2 1

13. 4 5 6

14. Right lower limb lead Right upper limb electrode Left upper limb electrode Left lower limb lead

15.  To get a clear trace the patient needs to remain as still as possible 2. Press ‘ECG’ 1. Wait for a full screen of clear, level trace 3. Press ‘Continue’ to print

17.  Anterior view of heart: › V 1 -V 4  Inferior view of heart: › II, III, aVF  Lateral view of heart: › I, aVL, V 5 -V 6

18.  Electrodes 1, 2, 3 - Traffic lights  Electrodes 4, 5, 6 - Brown, Black, ‘odd one out’ Purple  R arm, L arm, L leg - Traffic Lights  R Leg, ‘Earther’, black

19. 3 2 1 4 5 6