I. Skin Preparation

The skin will have to be cleaned before the surface elctrodes can be placed on the chest wall. This is accomplished by :

1. removing all body hair
2. vigorously wiping the shaved skin with alcohol to remove all of the skin's oils - this should be evidenced by a bright reddened area
3. dry the area thoroughly

II. Placement Of The EKG Electrodes

For the limb leads, place the electrodes as follows :

1. Place an electrode over the prepared skin medial to the anterior superior iliac spine on both the right and left sides of the hip
2. Place an electrode over the prepared skin medial to the anterior deltoid and just inferior to the lateral 1/3 of the clavicle on both the right and left shoulders

For the chest leads, place the electrodes as follows :

1. For V1, place the electrode in the fourth intercostal space on the right side of the sternum at the sternocostal margin
2. For V2, place the electrode in the fourth intercostal space on the left side of the sternum at the sternocostal margin
3. For V3, place the electrode in between V2 and V4
4. For V4, place the electrode in the fifth intercostal space in the midclavicular line beneath the nipple
5. For V5, place the electrode in between V4 and V6
6. For V6, place the electrode in the fifth intercostal space in the midaxillary line

III. Assignment :

1. Have your 12-lead EKG taken.
2. At the end of your 12 lead EKG, take in a deep breath and hold it while Lead II is running and then exhale. This will show you the effect of inhalation and expiration on your R to R intervals (heart rate).
3. Next, identify each of the waves in you EKG.
4. Measure the durations of the : P wave, PR interval, QRS complex, and what the amplitude displacement is for the ST segment - does it fall into the normal range ?
5. Find which leads in your 12-lead EKG have upside down P waves as well as a negatively displaced QRS complex.
6. Identify the limb leads which have Q waves.
7. Where is an R wave progression located and is there an R wave progression present in your 12-lead EKG ?
8. Which lead has the highest R wave deflection and what does that mean about the heart's electrical vector in relation to that lead ?