In Review: Lead Placement

Accurate lead placement is invaluable, and makes a significant impact on appropriate care trajectory, or misdiagnosis with unnecessary utilization of resources. A common finding associated with V1 / V2 malposition is P wave inversion, and rSr’ QRS with T wave inversion -- potentially leading clinicians to suspect Brugada pattern, for example, when no such entity exists. Another spurious finding is a QS pattern that mimics Anterior MI, and in the acute setting this may elicit compulsory urge to pursue invasive coronary intervention that is entirely unwarranted.

Tom Bouthillet demonstrates appropriate electrode application when capturing the pre-hospital 12 Lead ECG: