logging in or signing up Julio 12 lead EKG jdiaz911 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 7089 Category: Education License: All Rights Reserved Like it (11) Dislike it (0) Added: February 03, 2009 This Presentation is Public Favorites: 19 Presentation Description No description available. Comments Posting comment... By: jdiaz911 (6 month(s) ago) Hello everyone, I am sorry that I been away for sometime... Thank you all for your comments I am uploading some other powerpoints for your review. These are for downloads. Saving..... Post Reply Close Saving..... Edit Comment Close By: Gr8itude (12 month(s) ago) This is fabulous and perfect timing - I too am unable to download it. Is it possible to get a copy sent to me at medix821@gmail.com? I would love to keep a copy on my iPad for review. thank you - Teina Saving..... Post Reply Close Saving..... Edit Comment Close By: ghicks (18 month(s) ago) I have lost all my powerpoints and have a clas this weekend, I think portions of your powerpoint would be great to use, could you send me the powerpoint, please. Thank you, It is a great ppt. Gary Saving..... Post Reply Close Saving..... Edit Comment Close By: bobmurray4007 (24 month(s) ago) Love the slides ... any chance I can get them sent to me at bmurray@dpsjfd.org. They won't seem to download for me. Thanks a ton. Saving..... Post Reply Close Saving..... Edit Comment Close By: 1ccftn (27 month(s) ago) Hi, I would llike to use some of your slides for teaching. I'm a nurse educator for Critical care and IMU. Great job!! Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript 12 Lead ECG Interpretation: Quick review for Assessing for MI’s : 12 Lead ECG Interpretation: Quick review for Assessing for MI’s Julio Diaz NREMT-P TEMS Training Officer Gwinnett Fire Academy 1 Objectives : review the ECG waveform and intervals Define myocardial ischemia, injury and infarction Identify the 5 major infarct areas on the 12 lead Name occluded arteries common to the area Differentiate ECG changes reflecting ischemia, injury and infarction Identify cardiac enzymes associated with ACS 2 Objectives MI Definition : A result of occlusion of arterial flow to the myocardium. Ischemia, injury and necrosis is result Occlusion occurs via spasm, blood clot or stenosis 3 MI Definition Slide 4: 4 The Three I’s Ischemia lack of oxygenation ST segment depression or T wave inversion Injury prolonged ischemia ST segment elevation Infarct death of tissue may or may not show a Q wave Slide 5: 5 Injury/Infarct Recognition Epicardial Coronary Artery Lateral Wall of LV Positive Electrode Septum Interior Wall of LV Well Perfused Myocardium Slide 6: Injury/Infarct Recognition Normal ECG Injury/Infarct Recognition : Injury/Infarct Recognition Epicardial Coronary Artery Lateral Wall of LV Septum Interior Wall of LV Ischemia Positive Electrode Left Ventricular Cavity Injury/Infarct Recognition : Injury/Infarct Recognition Ischemia Inadequate oxygen to tissue Represented by ST depression or T inversion May or may not result in infarct or Q waves Injury/Infarct Recognition : Injury/Infarct Recognition ST Segment Depression Injury/Infarct Recognition : Injury/Infarct Recognition Thrombus Ischemia Injury Injury/Infarct Recognition : Injury/Infarct Recognition ST Segment Elevation Injury/Infarct Recognition : Injury/Infarct Recognition Infarcted Area Electrically Silent Depolarization Infarct Injury/Infarct Recognition : Injury/Infarct Recognition Infarct Death of tissue Represented by Q wave Not all infarcts develop Q waves Localization : Localization Inferior: II, III, AVF Septal: V1, V2 Anterior: V3, V4 Lateral: I, AVL, V5, V6 Localization : Localization I Lateral II Inferior III Inferior aVR aVL Lateral V1 Septal aVF Inferior V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral Which coronary arteries are most likely associated with each group of contiguous leads? Localization: Left Coronary Artery : Localization: Left Coronary Artery Left Main Left Circumflex Lateral Wall Anterior Wall of Left Ventricle Septal Wall Right Ventricle Right Coronary Artery Anterior Descending Artery Slide 17: Localization: Left Coronary Artery (LCA) Left Main (proximal LCA) occlusion Extensive Anterior injury Left Circumflex (LCX) occlusion Lateral injury Left Anterior Descending (LAD) occlusion Anteroseptal injury Localization: Extensive Anterior MI : Localization: Extensive Anterior MI Evidence in septal, anterior, and lateral leads Often from proximal LCA lesion “Widow Maker” Complications common Left ventricular failure CHF / Pulmonary Edema Cardiogenic Shock Localization: Right Coronary Artery (RCA) : Localization: Right Coronary Artery (RCA) Proximal RCA occlusion Right Ventricle injured Posterior wall of left ventricle injured Inferior wall of left ventricle injured Posterior descending artery (PDA) occlusion Inferior wall of right ventricle injured Localization Summary : Localization Summary Left Coronary Artery Septal Anterior Lateral Possibly Inferior Right Coronary Artery Inferior Right Ventricular Infarct Posterior Evolution of AMI : Evolution of AMI Hyperacute Early change suggestive of AMI Tall & Peaked May precede clinical symptoms Only seen in leads looking at infarcting area Not used as a diagnostic finding Slide 22: Evolution of AMI Acute ST segment elevation Implies myocardial injury occurring Elevated ST segment presumed acute rather than old Evolution of AMI : Evolution of AMI Age Undetermined Wide (pathologic) Q wave No ST segment elevation Old or “age undetermined” MI AMI Recognition : AMI Recognition A normal 12-lead ECG DOES NOT mean the patient is not having acute ischemia, injury or infarction!!! Reciprocal Changes : Reciprocal Changes Reciprocal Changes : Reciprocal Changes II, III, aVF I, aVL, V leads Slide 27: ST segment elevation is presumptive evidence for AMI Precordial Leads : 28 Precordial Leads Slide 29: 29 12-Lead ECG AMI recognition Two things to know What to look for Where you are looking Slide 30: 30 Where the positive electrode is positioned, determines what part of the heart is seen! Slide 31: 31 Lead “Views” Slide 32: 32 Limb Leads Chest Leads I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Lead Groups The ECG Tracing : 33 The ECG Tracing ECG Changes : Ischemia : T-wave inversion ( flipped T) ST segment depression T wave flattening Biphasic T-waves 34 ECG Changes : Ischemia ECG Changes: Injury : ST segment elevation of greater than 1mm in at least 2 contiguous leads Heightened or peaked T waves Directly related to portions of myocardium rendered electrically inactive 35 ECG Changes: Injury Baseline Slide 36: 36 Inferior Wall II, III, aVF View from Left Leg ? inferior wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Inferior MI : 37 Inferior MI Slide 38: 38 Lateral Wall I and aVL View from Left Arm ? lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Slide 39: Lateral Wall V5 and V6 Left lateral chest lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral Wall : Lateral Wall Lateral Wall I, aVL, V5, V6 ST elevation ? suspect lateral wall injury Anterior Wall : Anterior Wall V3, V4 Left anterior chest ? electrode on anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral MI : 42 Lateral MI Anterior Wall : Anterior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 V3, V4 ST segment elevation ? suspect anterior wall injury Slide 44: Septal Wall V1, V2 Along sternal borders Look through right ventricle & see septal wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Slide 45: Septal I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 V1, V2 septum is left ventricular tissue Right Sided EKG???? : Right Sided EKG???? RVI occurs around 40% in inferior MI’s Significance Larger area of infarct Both ventricles Different treatment Right leads “look” directly at Right Ventricle and can show ST elevations in leads II. III. AVF, V4R , V5R and V6R Occlusion in RCA and proximal enough to involve the RV 46 The single most accurate tool used in measuring RVI. 90% sensitive and specific Posterior Leads : Posterior Leads Posterior leads V1, V2 Posterior Infarct with ST Depressions and/ tall R wave RCA and/or LCX Artery Understand Reciprocal changes The posterior aspect of the heart is viewed as a mirror image and therefore depressions versus elevations indicate MI Rarely by itself usually in combo 47 Practice 1 : 48 Practice 1 Anterior MI with lateral involvement ST elevations V2, V3, V4 ST elevations II, AVL, V5 Practice 2 : 49 Practice 2 Anteroseptal MI ST elevations V1, V2, V3, V4 Practice 3 : 50 Practice 3 Inferior MI ST elevation 2,3 AVF Practice 4 : 51 Practice 4 Inferior lateral MI ST elevations 2, 3, AVF ST elevations V5 Practice 5 : 52 Practice 5 Acute inferior MI Lateral ischemia Additional Practice Strips : 53 Additional Practice Strips Additional Practice Strips : 54 Additional Practice Strips Additional Practice Strips : 55 Additional Practice Strips Additional Practice Strips : 56 Additional Practice Strips Additional Practice Strips : 57 Additional Practice Strips Additional Practice Strips : 58 Additional Practice Strips Additional Practice Strips : 59 Additional Practice Strips Additional Practice Strips : 60 Additional Practice Strips Additional Practice Strips : 61 Additional Practice Strips Additional Practice Strips : 62 Additional Practice Strips Additional Practice Strips : 63 Additional Practice Strips Additional Practice Strips : 64 Additional Practice Strips Additional Practice Strips : 65 Additional Practice Strips Additional Practice Strips : 66 Additional Practice Strips Additional Practice Strips : 67 Additional Practice Strips Additional Practice Strips : 68 Additional Practice Strips Cardiac Enzymes Indicating Infarct : Normals CPK- 10-155u/liter begin rise 3-6 hours and peaks 12-24 with return to norm 3-5 days CPK-MB < than 5% IU/liter LDH 85-200 IU/liter Begin rise 12 hours, peaks 36-72 and normal around 10 days LDH 1- 18.1% - 29% of total LDH 2- 27.4% to 37.5% of total 69 Cardiac Enzymes Indicating Infarct Cardiac Enzymes Indicating Infarct : Cardiac Enzymes Indicating Infarct Troponins- Now the Gold Standard! Rises after 3-6 hours Negative Troponin within 6 hours of onset of S&S rules out the MI Peaks at about 20 hours May be raised for 14 days 70 Cardiac Enzymes Indicating Infarct : Troponin T 84% sensitivity for MI 8 hours after onset of symptoms 22% for unstable angina Advantages Highly sensitive for detecting myocardial ischemia Levels may help to stratify risks Disadvantages Less specific than Troponin I Increased in angina Increased in chronic renal failure 71 Cardiac Enzymes Indicating Infarct Cardiac Enzymes Indicating Infarct : Troponin I 90% sensitivity for MI 8 hours after onset of S&S and 95% specificity Level greater than 1.2 suggest MI Negative rules out MI Obtain two negative troponin values 4 hours apart Normally exceedingly low Even a small elevation indicates myocardial damage 72 Cardiac Enzymes Indicating Infarct References : Twelve Lead Electrocardiography for ACLS Providers, D. Bruce Foster, D.O.W.B. Saunders Company Rapid Interpretation of EKG’s , Dale Dubin, M.D., Cover Publishing Co. 1998 ECG’s Made Easy, Barbara Aehlert, RN, Mosby, 1995 The 12 Lead ECG in Acute Myocardial Infarction, Tim Phalen, Mosby, 1996 Color Coding EKG’s , Tim Carrick, RN, H &H Publishing, 1994 www.ecglibrary.com/ecghome.html www.urbanhealth.udmercy.edu/ekg/read.html www.ecglibrary.com/ecghome.html www.nyerrn.com/h/ekg.htm Drawings by Jill Gregory, Medical Illustrator, CGEY 73 References You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Julio 12 lead EKG jdiaz911 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 7089 Category: Education License: All Rights Reserved Like it (11) Dislike it (0) Added: February 03, 2009 This Presentation is Public Favorites: 19 Presentation Description No description available. Comments Posting comment... By: jdiaz911 (6 month(s) ago) Hello everyone, I am sorry that I been away for sometime... Thank you all for your comments I am uploading some other powerpoints for your review. These are for downloads. Saving..... Post Reply Close Saving..... Edit Comment Close By: Gr8itude (12 month(s) ago) This is fabulous and perfect timing - I too am unable to download it. Is it possible to get a copy sent to me at medix821@gmail.com? I would love to keep a copy on my iPad for review. thank you - Teina Saving..... Post Reply Close Saving..... Edit Comment Close By: ghicks (18 month(s) ago) I have lost all my powerpoints and have a clas this weekend, I think portions of your powerpoint would be great to use, could you send me the powerpoint, please. Thank you, It is a great ppt. Gary Saving..... Post Reply Close Saving..... Edit Comment Close By: bobmurray4007 (24 month(s) ago) Love the slides ... any chance I can get them sent to me at bmurray@dpsjfd.org. They won't seem to download for me. Thanks a ton. Saving..... Post Reply Close Saving..... Edit Comment Close By: 1ccftn (27 month(s) ago) Hi, I would llike to use some of your slides for teaching. I'm a nurse educator for Critical care and IMU. Great job!! Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript 12 Lead ECG Interpretation: Quick review for Assessing for MI’s : 12 Lead ECG Interpretation: Quick review for Assessing for MI’s Julio Diaz NREMT-P TEMS Training Officer Gwinnett Fire Academy 1 Objectives : review the ECG waveform and intervals Define myocardial ischemia, injury and infarction Identify the 5 major infarct areas on the 12 lead Name occluded arteries common to the area Differentiate ECG changes reflecting ischemia, injury and infarction Identify cardiac enzymes associated with ACS 2 Objectives MI Definition : A result of occlusion of arterial flow to the myocardium. Ischemia, injury and necrosis is result Occlusion occurs via spasm, blood clot or stenosis 3 MI Definition Slide 4: 4 The Three I’s Ischemia lack of oxygenation ST segment depression or T wave inversion Injury prolonged ischemia ST segment elevation Infarct death of tissue may or may not show a Q wave Slide 5: 5 Injury/Infarct Recognition Epicardial Coronary Artery Lateral Wall of LV Positive Electrode Septum Interior Wall of LV Well Perfused Myocardium Slide 6: Injury/Infarct Recognition Normal ECG Injury/Infarct Recognition : Injury/Infarct Recognition Epicardial Coronary Artery Lateral Wall of LV Septum Interior Wall of LV Ischemia Positive Electrode Left Ventricular Cavity Injury/Infarct Recognition : Injury/Infarct Recognition Ischemia Inadequate oxygen to tissue Represented by ST depression or T inversion May or may not result in infarct or Q waves Injury/Infarct Recognition : Injury/Infarct Recognition ST Segment Depression Injury/Infarct Recognition : Injury/Infarct Recognition Thrombus Ischemia Injury Injury/Infarct Recognition : Injury/Infarct Recognition ST Segment Elevation Injury/Infarct Recognition : Injury/Infarct Recognition Infarcted Area Electrically Silent Depolarization Infarct Injury/Infarct Recognition : Injury/Infarct Recognition Infarct Death of tissue Represented by Q wave Not all infarcts develop Q waves Localization : Localization Inferior: II, III, AVF Septal: V1, V2 Anterior: V3, V4 Lateral: I, AVL, V5, V6 Localization : Localization I Lateral II Inferior III Inferior aVR aVL Lateral V1 Septal aVF Inferior V2 Septal V3 Anterior V4 Anterior V5 Lateral V6 Lateral Which coronary arteries are most likely associated with each group of contiguous leads? Localization: Left Coronary Artery : Localization: Left Coronary Artery Left Main Left Circumflex Lateral Wall Anterior Wall of Left Ventricle Septal Wall Right Ventricle Right Coronary Artery Anterior Descending Artery Slide 17: Localization: Left Coronary Artery (LCA) Left Main (proximal LCA) occlusion Extensive Anterior injury Left Circumflex (LCX) occlusion Lateral injury Left Anterior Descending (LAD) occlusion Anteroseptal injury Localization: Extensive Anterior MI : Localization: Extensive Anterior MI Evidence in septal, anterior, and lateral leads Often from proximal LCA lesion “Widow Maker” Complications common Left ventricular failure CHF / Pulmonary Edema Cardiogenic Shock Localization: Right Coronary Artery (RCA) : Localization: Right Coronary Artery (RCA) Proximal RCA occlusion Right Ventricle injured Posterior wall of left ventricle injured Inferior wall of left ventricle injured Posterior descending artery (PDA) occlusion Inferior wall of right ventricle injured Localization Summary : Localization Summary Left Coronary Artery Septal Anterior Lateral Possibly Inferior Right Coronary Artery Inferior Right Ventricular Infarct Posterior Evolution of AMI : Evolution of AMI Hyperacute Early change suggestive of AMI Tall & Peaked May precede clinical symptoms Only seen in leads looking at infarcting area Not used as a diagnostic finding Slide 22: Evolution of AMI Acute ST segment elevation Implies myocardial injury occurring Elevated ST segment presumed acute rather than old Evolution of AMI : Evolution of AMI Age Undetermined Wide (pathologic) Q wave No ST segment elevation Old or “age undetermined” MI AMI Recognition : AMI Recognition A normal 12-lead ECG DOES NOT mean the patient is not having acute ischemia, injury or infarction!!! Reciprocal Changes : Reciprocal Changes Reciprocal Changes : Reciprocal Changes II, III, aVF I, aVL, V leads Slide 27: ST segment elevation is presumptive evidence for AMI Precordial Leads : 28 Precordial Leads Slide 29: 29 12-Lead ECG AMI recognition Two things to know What to look for Where you are looking Slide 30: 30 Where the positive electrode is positioned, determines what part of the heart is seen! Slide 31: 31 Lead “Views” Slide 32: 32 Limb Leads Chest Leads I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Lead Groups The ECG Tracing : 33 The ECG Tracing ECG Changes : Ischemia : T-wave inversion ( flipped T) ST segment depression T wave flattening Biphasic T-waves 34 ECG Changes : Ischemia ECG Changes: Injury : ST segment elevation of greater than 1mm in at least 2 contiguous leads Heightened or peaked T waves Directly related to portions of myocardium rendered electrically inactive 35 ECG Changes: Injury Baseline Slide 36: 36 Inferior Wall II, III, aVF View from Left Leg ? inferior wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Inferior MI : 37 Inferior MI Slide 38: 38 Lateral Wall I and aVL View from Left Arm ? lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Slide 39: Lateral Wall V5 and V6 Left lateral chest lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral Wall : Lateral Wall Lateral Wall I, aVL, V5, V6 ST elevation ? suspect lateral wall injury Anterior Wall : Anterior Wall V3, V4 Left anterior chest ? electrode on anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Lateral MI : 42 Lateral MI Anterior Wall : Anterior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 V3, V4 ST segment elevation ? suspect anterior wall injury Slide 44: Septal Wall V1, V2 Along sternal borders Look through right ventricle & see septal wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Slide 45: Septal I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 V1, V2 septum is left ventricular tissue Right Sided EKG???? : Right Sided EKG???? RVI occurs around 40% in inferior MI’s Significance Larger area of infarct Both ventricles Different treatment Right leads “look” directly at Right Ventricle and can show ST elevations in leads II. III. AVF, V4R , V5R and V6R Occlusion in RCA and proximal enough to involve the RV 46 The single most accurate tool used in measuring RVI. 90% sensitive and specific Posterior Leads : Posterior Leads Posterior leads V1, V2 Posterior Infarct with ST Depressions and/ tall R wave RCA and/or LCX Artery Understand Reciprocal changes The posterior aspect of the heart is viewed as a mirror image and therefore depressions versus elevations indicate MI Rarely by itself usually in combo 47 Practice 1 : 48 Practice 1 Anterior MI with lateral involvement ST elevations V2, V3, V4 ST elevations II, AVL, V5 Practice 2 : 49 Practice 2 Anteroseptal MI ST elevations V1, V2, V3, V4 Practice 3 : 50 Practice 3 Inferior MI ST elevation 2,3 AVF Practice 4 : 51 Practice 4 Inferior lateral MI ST elevations 2, 3, AVF ST elevations V5 Practice 5 : 52 Practice 5 Acute inferior MI Lateral ischemia Additional Practice Strips : 53 Additional Practice Strips Additional Practice Strips : 54 Additional Practice Strips Additional Practice Strips : 55 Additional Practice Strips Additional Practice Strips : 56 Additional Practice Strips Additional Practice Strips : 57 Additional Practice Strips Additional Practice Strips : 58 Additional Practice Strips Additional Practice Strips : 59 Additional Practice Strips Additional Practice Strips : 60 Additional Practice Strips Additional Practice Strips : 61 Additional Practice Strips Additional Practice Strips : 62 Additional Practice Strips Additional Practice Strips : 63 Additional Practice Strips Additional Practice Strips : 64 Additional Practice Strips Additional Practice Strips : 65 Additional Practice Strips Additional Practice Strips : 66 Additional Practice Strips Additional Practice Strips : 67 Additional Practice Strips Additional Practice Strips : 68 Additional Practice Strips Cardiac Enzymes Indicating Infarct : Normals CPK- 10-155u/liter begin rise 3-6 hours and peaks 12-24 with return to norm 3-5 days CPK-MB < than 5% IU/liter LDH 85-200 IU/liter Begin rise 12 hours, peaks 36-72 and normal around 10 days LDH 1- 18.1% - 29% of total LDH 2- 27.4% to 37.5% of total 69 Cardiac Enzymes Indicating Infarct Cardiac Enzymes Indicating Infarct : Cardiac Enzymes Indicating Infarct Troponins- Now the Gold Standard! Rises after 3-6 hours Negative Troponin within 6 hours of onset of S&S rules out the MI Peaks at about 20 hours May be raised for 14 days 70 Cardiac Enzymes Indicating Infarct : Troponin T 84% sensitivity for MI 8 hours after onset of symptoms 22% for unstable angina Advantages Highly sensitive for detecting myocardial ischemia Levels may help to stratify risks Disadvantages Less specific than Troponin I Increased in angina Increased in chronic renal failure 71 Cardiac Enzymes Indicating Infarct Cardiac Enzymes Indicating Infarct : Troponin I 90% sensitivity for MI 8 hours after onset of S&S and 95% specificity Level greater than 1.2 suggest MI Negative rules out MI Obtain two negative troponin values 4 hours apart Normally exceedingly low Even a small elevation indicates myocardial damage 72 Cardiac Enzymes Indicating Infarct References : Twelve Lead Electrocardiography for ACLS Providers, D. Bruce Foster, D.O.W.B. Saunders Company Rapid Interpretation of EKG’s , Dale Dubin, M.D., Cover Publishing Co. 1998 ECG’s Made Easy, Barbara Aehlert, RN, Mosby, 1995 The 12 Lead ECG in Acute Myocardial Infarction, Tim Phalen, Mosby, 1996 Color Coding EKG’s , Tim Carrick, RN, H &H Publishing, 1994 www.ecglibrary.com/ecghome.html www.urbanhealth.udmercy.edu/ekg/read.html www.ecglibrary.com/ecghome.html www.nyerrn.com/h/ekg.htm Drawings by Jill Gregory, Medical Illustrator, CGEY 73 References