Who Foundations Level Is For:
Designed as a starting point for students or early EM/acute care learners, with a focus on building a safe, repeatable ECG approach. It is also appropriate for paramedics, nurses, APPs, ED technicians, and any clinician who wants to strengthen ECG fundamentals for acute care decision-making.
Foundations Level Goals:
By the end of Foundations, you should be able to:
- Use a consistent stepwise approach on every ECG (not “pattern-hunting” only).
- Identify normal baseline findings and common normal variants.
- Recognize obvious instability and life-threatening rhythms, but always confirm with the patient, vital signs, and clinical story.
- Understand what the ECG can and cannot tell you without clinical correlation.
How to Use Foundations Level:
- Start with the modules below and work in order.
- Read the linked ECG STAT posts until you can explain the pattern and the “so what” out loud.
- On each STAT post, complete the linked ECG Weekly Workouts and their associated workout quizzes to build pattern recognition.
- When an ECG Skills exam is available for a topic, use it as your check.
- Revisit modules where you miss questions, feel slow, or feel uncertain.
Core Topics and Modules
Module 1: ECG Purpose & A Safe Approach
What you should be able to do:
- Explain what the ECG is used for in acute care and what it cannot reliably exclude.
- Apply a consistent approach that survives real ED workflow.
Recommended ECG STATs:
Practice and assessment
- Use the Related Weekly Workouts on each STAT page and complete their workout quizzes.
- Complete any linked ECG Skills exams when available.
Module 2: Foundations of the ECG Tracing
What you should be able to do
- Identify waveforms, segments, and intervals and explain what they represent physiologically.
- Understand basic conduction and why vectors matter.
Recommended ECG STATs:
Module 3: Lead Placement and “is this tracing real?”
What you should be able to do
- Recognize when lead placement or artifact is contaminating the ECG.
- Avoid “treating the monitor” without verifying the tracing.
Recommended ECG STATs:
Module 4: Rate, Rhythm, Axis, Voltage, QRS, ST Segment
What you should be able to do
- Produce a complete basic interpretation reliably: rate, rhythm, axis, intervals, QRS duration/morphology, ST-T changes.
- Recognize when something is abnormal enough to demand clinical escalation.
Recommended ECG STATs:
Module 5: Common Baseline Rhythms & What Makes Them Dangerous
What you should be able to do
- Recognize common rhythms and identify when the patient’s stability changes your response.
- Distinguish “an ECG diagnosis” from “a clinical decision.”
Recommended ECG STATs:
Module 6: Intro to Ischemia and Injury Patterns
What you should be able to do
- Explain what ST elevation and ST depression can mean and why context matters.
- Avoid over-calling STEMI from the ECG alone, while still escalating appropriately when the story and ECG align.
Recommended ECG STATs:
Module 7: Basic Recognition of Life-threatening Rhythms
What you should be able to do
- Recognize immediately fatal rhythms and connect ECG findings to patient responsiveness and perfusion.
- Understand the clinical implications of complete heart block.
Recommended ECG STATs:
Minimum Standard to Move On:
You are ready for the next level when you can:
- Use a repeatable approach and produce a coherent interpretation in under 60–90 seconds.
- Reliably identify normal sinus rhythm and common benign findings.
- Recognize obvious instability and life threats and tie your response to the patient, not the tracing alone.
- Explain when an ECG finding is “possible ischemia” versus “actionable OMI concern,” based on symptoms and risk.
Common Failure Modes to Avoid:
- Treating the monitor without verifying the rhythm is real (artifact, lead misplacement).
- Using the ECG alone to “rule out” ACS or other critical illness.
- Anchoring on the machine read when the patient looks sick.
- Calling STEMI or “no STEMI” without integrating symptoms, vitals, and pretest probability.
Designed for medical students, new interns, paramedics, nurses, APPs, and any clinician who wants a solid baseline. Learn a consistent approach to rate, rhythm, axis, intervals, conduction, and normal variants, with constant emphasis on clinical context and common pitfalls.
Designed as a PGY-1 guide, but appropriate for any clinician moving from “I can interpret” to “I can triage safely.” Build speed and reliability with high-frequency ED rhythms, early ischemia recognition, and rapid identification of life-threatening patterns.
Designed as a PGY-2 guide, but useful for clinicians who want deeper confidence with nuance. Expand into conduction blocks, wide-QRS differentiation, subtle ischemic patterns, tox and metabolic ECGs, and higher-level arrhythmia interpretation.
Designed as a PGY-3 guide, but built for anyone tackling complex ECGs under pressure. Focus on STEMI equivalents, difficult OMI patterns, rare syndromes, and the clinical integration that separates correct interpretation from correct decisions.
Designed for senior residents and attendings, and for any clinician who teaches others. Emphasizes rapid pattern recognition, case-based reasoning, avoiding cognitive traps, and practical teaching frameworks you can use on shift.
