Cardiac & ECG

The strip, the arrest, and the peri-arrest patient who still has a pulse. Pit-crew CPR, STEMI and the views a 12-lead hides, pacing, cardioversion, TOR, pregnancy and hypothermia arrest, cardiogenic shock, and dissection you must not treat like ACS.

Related Practice

Apply It Interactively

Field Tool

CardioStrip

Practice the lessons above on 6-second Lead II strips and teaching 12-leads — STEMI patterns, occlusion warnings, extra leads, and mimics.

Open 12-Lead practice Lead II strips EMS Toolkit

Lessons

Suggested order

Twenty-nine modules in this path. Progress is saved on this device after you pass a quiz.

1
Systematic ECG ApproachRate → regularity → P → PR → QRS → interpret.
2
AV Blocks: Three-Question Path1°, Mobitz I/II, complete block.
3
Stable vs Unstable TachycardiaPerfusion decides urgency — not rate alone.
4
Wide-Complex Tachycardia: VT vs MimicsVT-first safety for regular WCT.
5
PEA: Without a PulseOrganized electricity without output.
6
Asystole vs Fine VFVerify before you choose the shock pathway.
7
ROSC & Post-Arrest CarePackage the patient after pulses return.
8
12-Lead STEMI Recognition12-lead within 10 minutes of first medical contact when ACS is on the table. Transmit. PCI destination.
9
Symptomatic BradycardiaBradycardia with poor perfusion: ABCs, pads on, atropine/pacing per protocol — don’t wait on a strip argument.
10
Shockable Arrest: VF & pVTShockable arrest: defibrillate, immediate CPR, minimize pauses, reassess on the clock.
11
High-Quality CPRRate, depth, recoil, short pauses, 30:2. Advanced airway: 10 breaths/min, continuous compressions.
12
SVT & Adenosine FramingRegular narrow-complex: vagal, adenosine if stable. Unstable: synchronized cardioversion. Not AF.
13
Atrial Fibrillation with RVRIrregularly irregular. Cardiovert if unstable. Rate control if stable. Do not adenosine-treat AF.
14
Hyperkalemia on the MonitorPeaked T → wide QRS → sine wave. Calcium for ECG toxicity. Shift and remove K per protocol.
15
Right-Sided & Posterior MIV4R for inferior/RV. V7–V9 for posterior. Nitro caution when the right ventricle is the pump.
16
Pit-Crew CPR ChoreographyRoles out loud. Switch compressors ~2 min. Pads while compressing. Pulse checks stay short.
17
Transcutaneous Pacing in the FieldUnstable bradycardia: TCP. Confirm a pulse with each paced QRS. Protocol owns sedation.
18
Synchronized Cardioversion in the FieldUnstable SVT/AF/VT with a pulse → synchronized cardioversion. Confirm sync. Protocol owns energy.
19
Double Sequential Defibrillation FramingRefractory VF: high-quality CPR, standard defib first. DSED/vector-change only if protocol says so.
20
Termination of ResuscitationFollow your TOR rule and medical control. Do not improvise futility. Document the clock.
21
Hypothermic Cardiac ArrestHandle gently. CPR. Rewarming destination. AHA 2025 special circumstances — not a driveway TOR.
22
Cardiac Arrest in PregnancyLUD, high-quality CPR, standard defib. Perimortem hysterotomy is a hospital/system skill — know your plan.
23
Opioid-Associated Cardiac ArrestPulseless: high-quality CPR. Naloxone must not steal compressions. Pulse + apnea: ventilate, then naloxone.
24
Cardiogenic Shock in the FieldCardiogenic shock is a destination and airway problem. Do not treat it like hypovolemia.
25
Aortic Dissection: Field SuspicionSudden tearing pain ± pulse deficit ± neuro. Hold the ACS reflex. Aorta-capable destination.
26
STEMI Equivalents: Transmit AnywayHyperacute T, de Winter, Wellens, isolated posterior, uncertain LBBB/paced: transmit and talk like a STEMI.
27
Pre-Excited AF (WPW): Do Not Block the NodeIrregular + wide: no AV-nodal blockers. Unstable → synchronized cardioversion. Protocol owns the stable drug.
28
LVAD Emergencies: Is It Really Arrest?Hum? MAP? Mentation? Restart the controller. CPR only if truly lifeless per AHA LVAD framing.
29
Defibrillation Pads & Vector ChangeAnterolateral first. Clear the heart. AP vector change only after failed shocks if your system allows it.