EKG's on morbidly obese

[stillpressingon]

I've done a tremendous number of EKG's but the one problem I still consistenly deal with is finding the "fourth intercostal space" on pt's who are morbidly obese - usually about 250+ lbs overweight. On pt's who are too-thin to those who are obese (but not morbidly) I have no problem finding it. Is it just a matter of eye-balling it??

[getoverit, BSN, RN, EMT-P]

Finding any ICS on an obese patient is hard. You just have to eyeball it if you can't actually palpate it. I've seen 12 leads applied that were way off the mark, with an obese patient you have to make due with what you've got, the best you can.

It may be easier to palpate the substernal angle and work your way to the midclavicular line from there.