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Emergency Medicine · Paramedic

Paramedic: 12-Lead EKG and ACS Recognition

Prehospital 12-lead EKG acquisition and acute coronary syndrome recognition concepts tested on paramedic certification exams.

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Where is the V1 electrode placed in a 12-lead EKG?
4th intercostal space, right sternal border
Where is the V2 electrode placed in a 12-lead EKG?
4th intercostal space, left sternal border
Where is the V3 electrode placed in a 12-lead EKG?
Midway between V2 and V4
Where is the V4 electrode placed in a 12-lead EKG?
5th intercostal space, left midclavicular line
Where is the V5 electrode placed in a 12-lead EKG?
Left anterior axillary line, level with V4
Where is the V6 electrode placed in a 12-lead EKG?
Left midaxillary line, level with V4 and V5
Where is the RA (right arm) limb electrode placed?
On the right arm or right shoulder
Where is the LA (left arm) limb electrode placed?
On the left arm or left shoulder
Where is the LL (left leg) limb electrode placed?
On the left leg
What is the purpose of the V4R lead?
To detect right ventricular infarction
How is the V4R electrode positioned relative to V4?
In the mirror-image position on the right side of the chest (5th intercostal space, right midclavicular line)
What is the purpose of posterior leads V7 through V9?
To detect posterior wall myocardial infarction, which the standard 12 leads can miss
Standard EKG paper speed is ____.
25 mm/sec
Standard EKG calibration is ____.
10 mm/mV
How much time does one small box on EKG paper represent?
0.04 seconds (40 ms)

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