Who Core Level Is For:
Designed as a PGY-1 guide for emergency medicine residents, focused on triage-level safety and building speed without missing danger. It is also appropriate for any acute care clinician who already has a basic ECG approach and wants to reliably recognize high-risk ECGs and make the right next clinical move under time pressure.
Core Level Goals:
By the end of Core, you should be able to:
- Use a consistent, complete ECG approach under real ED time pressure.
- Rapidly identify unstable rhythms and immediately life-threatening patterns, then confirm instability at the bedside.
- Recognize ischemic ECG patterns that require urgent escalation, including commonly missed occlusion patterns (posterior and high-lateral).
- Safely approach wide complex tachycardia and avoid dangerous “SVT assumptions.”
- Avoid common early errors: treating artifact, over-trusting the computer interpretation, and declaring “no STEMI” when the ECG is high-risk.
How to Use Core 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: A Core Bedside Method That Scales
What you should be able to do:
- Apply a consistent stepwise approach that works for every ECG, every shift.
- Avoid “pattern hunting” that skips critical checks (rate, rhythm, axis, intervals, QRS width/morphology, ST-T changes, and artifact/lead placement).
- Recognize when a tracing is not reliable enough to act on without verification.
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: Bradycardia, AV Block, and "Is this patient perfusing?"
What you should be able to do
- Identify unstable bradycardia and link it to perfusion and symptoms, not the monitor.
- Recognize high-grade and complete AV block patterns that require escalation and pacing readiness.
- Avoid dismissing conduction disease when the patient “looks okay” but the ECG is high-risk.
Recommended ECG STATs:
Module 3: Tachycardia, SVT, and Common Pitfalls
What you should be able to do
- Decide when tachycardia is a rhythm problem versus a physiology problem.
- Recognize SVT patterns quickly and identify when “SVT treatment” is unsafe.
- Use clinical context (shock, chest pain, altered mental status) to drive urgency.
Recommended ECG STATs:
Module 4: Atrial Fibrillation & Flutter in the ED
What you should be able to do
- Recognize AF and flutter quickly, then apply stability and context before choosing rate control, rhythm control, or escalation.
- Identify when AF with pre-excitation is present or suspected and avoid AV nodal blockers when unsafe.
- Avoid anchoring on “rate control first” when the patient is unstable.
Recommended ECG STATs:
Module 5: Wide Complex Tachycardia Safety
What you should be able to do
- Treat wide complex tachycardia as VT until proven otherwise in high-risk patients.
- Recognize common mimics and avoid dangerous reassurance from the computer read.
- Know when a “stable-looking monitor” is misleading.
Recommended ECG STATs:
Module 6: Cardiac Arrest Rhythm Recognition
What you should be able to do
- Rapidly identify VF, pVT, PEA, and asystole and align the ECG pattern with the resuscitation phase.
- Avoid false rhythm labels due to artifact or lead issues during CPR.
Recommended ECG STATs:
Module 7: ACS and the Common Misses That Matter
What you should be able to do
- Apply STEMI criteria correctly, including pitfalls that cause both overcalls and misses.
- Recognize posterior and high-lateral occlusion patterns that often present with subtle changes.
- Escalate appropriately based on symptoms, ECG, and consequence of delay.
Recommended ECG STATs:
Module 8: Two Big Mimics in Acute Care
What you should be able to do
- Distinguish early repolarization patterns from ischemia in the acute care setting.
- Recognize pericarditis patterns and avoid reflex STEMI labeling without clinical correlation.
- Know when uncertainty should trigger repeat ECGs and escalation rather than premature closure.
Recommended ECG STATs:
Minimum Standard to Move On:
You are ready for the next level when you can:
- Triage an ECG in under 60 seconds into “routine,” “needs serial evaluation,” or “needs immediate escalation.”
- Reliably recognize unstable bradycardia and tachycardia patterns and connect them to perfusion and symptoms.
- Treat wide complex tachycardia as VT by default in high-risk patients and avoid common mislabels.
- Recognize posterior and high-lateral occlusion patterns often enough that you do not miss them when it matters.
- Demonstrate that your interpretation changes appropriately with clinical context.
Common Failure Modes to Avoid:
- Over-trusting the computer interpretation, especially for wide QRS rhythms and ischemia calls.
- Treating artifact as a lethal rhythm or dismissing a lethal rhythm as artifact.
- Declaring “no STEMI” and moving on when the ECG is subtle but the clinical stakes are high.
- Managing rhythms without bedside confirmation of stability, symptoms, and perfusion.
- Premature closure when the ECG is nondiagnostic but the patient’s story is high-risk.
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.
