JPP Letters
Dear Editorial Team,
In your latest issue of the Journal of Paramedic Practice (Volume 10, Issue 9; September 2018), there was an article titled ‘Recognising ECG Landmarks’ written by Karen Simpson-Scott. I would firstly like to state that this was a well written article, and an enjoyable read; however, there are some concerns with the information/images within, that I feel require your urgent attention.
Figure 1, images 1 and 3 show incorrect limb lead/chest lead placements as otherwise correctly described in the article text. Where possible, upper limb leads should be placed proximal to the wrist and, ideally, on a bony prominence. Lower limb leads should be placed proximal to the ankle, again ideally, on a bony prominence. These standardised positions are ‘best practice’ as suggested by the Society for Cardiological Science and Technology (SCST) for obtaining an accurate electrocardiogram (ECG), but also as a standardised approach for serial ECG comparison, which may potentially be between different users and/or settings (i.e. hospital, ambulance, community, practice, etc). Ideally, any variation should be documented on the ECG trace. Image 3 shows incorrect chest lead placement. V1 and V2 are depicted proximal to the 2nd intercostal space, and too far from the border of the sternum. This therefore disrupts all other lead placements. Correct placement images can be found within SCST guidance.
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