Modified Chest Leads (was: Modified Leads "On the Ice")

Occasionally I receive emails from readers who ask various questions or submit interesting ECGs which I sometimes use as case studies on the Prehospital 12-Lead ECG blog.

Back in November I received an email from a reader who wrote:

Hello! I’m currently in Antarctica on a medical support contract. I was issued a 3-lead Lifepak 10 for use at the field camp I’m staffing.

I’m wondering if you know of any way to manipulate/ alter this type of monitor so as to be able to gain V-lead views?

I kind of remember being shown some sort of trick years ago but, someone told me that it was probably demonstrated with a 4-lead monitor.

Any ideas? Many thanks in advance for your help!

Kindest Regards,
Ernie

I wrote him back with the following reply:

Hi, Ernie!

It’s easy. You just put the negative electrode in the position of the left shoulder and the positive electrode in the position of V1 (for example) and the result is MCL-1 (modified chest lead 1) which mimics V1. If you place the positive electrode in the position of V2 it’s MCL-2, and so on.

The fact that it’s a 3-lead is irrelevant because even a 4-lead is technically still a 3-lead. By designating the 4th electrode as the “ground lead” you can view all 3 leads (I, II, and III) at the same time. With a 3-lead you can only view one at a time because the 3rd lead defaults to the ground lead. For example, if you’re viewing lead II with a 3-lead it’s white (negative) to red (positive) and the black becomes the ground lead. If you’re viewing lead III then it’s black (negative) to red (positive) and the white becomes the ground lead.

One final suggestion. If memory serves with a LP10 you have to hold down a button (maybe the print button) continuously until a DIAG appears in the corner of the monitor screen which puts you in a diagnostic frequency response (where the low frequency/high pass filter goes from 1 to 0.05 Hz) so you can record accurate ST-segments. I hope this helps! Thanks for the question. Have a great day! Stay warm! Send pictures too if you get a chance! I’ll put you on my blog! :)

Tom

Well, I just heard back from him yesterday:

Tom,

Not sure if you remember me; I was the guy working in Antarctica that got in touch with you a few months ago to learn how to gain modified chest leads with the LP-10.

Well, I didn’t forget about you. I got home to California a couple of weeks ago, and have been getting caught up on email ever since! As promised, I’ve attached some pictures. You have my full permission to use any of the pics on your blog; I won’t be offended if you don’t use any though – I understand that it would be an odd entry for a blog dedicated to 12 lead education!

While I didn’t have to connect any patients to the LP-10, I was happy that I knew how to gain MCL’s 1 thru 6 if need be. Thanks again for your prompt and informative reply back in November.

Let me know if you have any questions about the pictures, or anything else.

Take Care,
Ernie

Here are the pictures he sent.

Here’s Ernie after a well-deserved haircut!

Thanks, Ernie! I’m glad I could be of assistance! Welcome home.

4 Comments

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Justin
Rate Related VS. Primary ST-T Changes:
I'm not sold on true A-Fib, as there is a fusion beat/PAC visible in lead V1, additionally I think that the "U" waves are possibly atrial activity. This pt could be having a fib/ flutter pattern; but its hard to say without slowing down the rate and getting expert consultation from a cardiologist. I Would…
2014-09-22 23:20:29
Billy Bob
Rate Related VS. Primary ST-T Changes:
I think I will have to agree with Michael; I just don't see all that much evidence of WPW; typically with WPW & AF the complexes vary in width and morphology due to the combination of the accessory pathway and normal pathways which I just don't see here. The rate doesn't seem to match what…
2014-09-22 19:02:24
Christopher
59 year old male: chest pressure – Conclusion
I read back over the details on this case and they didn't include whether or not the patient was Left-dominant. Your hunch is probably correct!
2014-09-22 12:55:42
Jonathan
Magnesium and Cardiac Action Potential
I have a background in biochemistry, and so am able to navigate the medical science more than someone without this background. My mom has atrial fibrillation, and so I decided to do some investigation. I am AMAZED to find out how little her primary care doctor knows about Magnesium/Potassium/Calcium concentrations as they pertain to Atrial…
2014-09-22 03:46:58
Jeff
Rate Related VS. Primary ST-T Changes:
He's complaining of 10/10 chest pain that coincided with palpitations with a HR of 206 that is probably A-Fib. I am guessing that if you correct his rate you will allow his myocardium to become perfused again and his chest pain will subside. I would pre-sedate him with Midazolam 2mg and electrically cardiovert starting @…
2014-09-21 19:17:36

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