Page 221 - 2026 SMOG

12-LEAD ELECTROCARDIOGRAM
Clinical Indications
• Suspicion of arrhythmia
• Chest pain is believed to be of cardiac origin
• Toxic ingestion with cardiac side effects
Contraindications
• None
Procedure
• Ensure the patient is lying flat on the bed and place leads as per the diagram.
• If the patient is unstable, address any emergent issues prior to attempting the 12-lead EKG
• May have to shave and/or dry the patient for pad adhesion
• Once leads are in place, instruct the patient to remain still and limit any movements around the
patient (as much as possible)
• Press the button to obtain a 12-lead EKG
**Document procedure, results, and vital signs.**

• V1—4th intercostal space, right sternal
border
• V2—4th intercostal space, left sternal
border
• V3—placed equally between V2 & V4
• V4—5th intercostal space, midclavicular line
• V5—placed along the transverse line
between V4 & V6
• V6—transverse from V4, 5th intercostal
space, midaxillary line

2026 Standard Medical Operating Guidelines (SMOG) • 213