One of my pet peeves in the ICU is when we just randomly slap ECG electrodes on patients in “roughly” the right spot. The one I see done most often is the brown electrode (the precordial lead for the monitor). It’s often just slapped down wherever. In fact, I remember being taught the mnemonic devices “smoke over fire,” “snow on grass,” and “white on the right” when I was a new nurse to remember the limb leads. But the one that I was taught that is horribly incorrect is “brown is the sh*t in the middle.” Thus, it didn’t really matter where the brown electrode was placed.
But it does matter. There’s a lot of useful info that you can get if the leads are positioned correctly. And there are other ways to arrange all the leads on the monitor. Some of these will get you different information. One of these configurations is the Lewis Lead. Credited to Welsh cardiology Sir Thomas Lewis (it’s too bad I’m not Sir Bryan Boling…), this is a way of arranging the ECG electrodes to better detect atrial activity, such as amplifying the waves in atrial fibrillation.
Robert Buttner and Mike Cadogan over at Life in the Fast Lane have a great post describing the Lewis Lead, it’s history, it’s usefulness, and how to do it right. Check it out. And please, stop just putting the brown electrode wherever.
critical care notes 