An ECG simulator that models the electricity, not just the shape

Twenty-two rhythms, and none of them are the same template slowed down

Most low-cost monitor simulators give you a handful of ECG shapes and stretch or compress the same waveform to hit whatever heart rate you dial in. The Patient Simulator's rhythm catalog runs from normal sinus rhythm through ST changes, hyperkalemia, SVT, atrial fibrillation and flutter, a junctional escape rhythm, every major AV block, paced rhythms, ventricular tachycardia with a pulse, pulseless VT, ventricular fibrillation, asystole and PEA. Each one is its own model of how the heart's electrical system actually behaves, not a reskin of the last one.

A junctional rhythm that actually looks junctional

A slow junctional escape rhythm is easy to fake and easy to get wrong. Slow the heart rate down on a sinus template and you get sinus bradycardia with extra steps, which teaches a trainee nothing about telling the two apart. The Patient Simulator's junctional rhythm instead drops the preceding P wave entirely and adds a small, genuinely inverted P wave just after the QRS, the retrograde conduction a real junctional rhythm produces. That one detail is the actual differentiator a trainee has to learn to spot.

AV blocks that block independently, beat by beat

First-degree, Mobitz I (Wenckebach), Mobitz II and third-degree block are modeled as separate P-wave and QRS event trains rather than one repeating pattern. In Wenckebach, the PR interval genuinely lengthens from beat to beat until a QRS drops, the way it does on a real strip. Mobitz II holds a fixed 2:1 conduction ratio. Complete heart block runs a P-wave rhythm and a QRS rhythm that are fully independent of each other, which is the entire diagnostic point of third-degree block and the hardest thing for a simplified simulator to fake convincingly. Turning that modeling into a recognition reflex rather than a one-time explanation is the subject of drilling AV block recognition until it's automatic.

The screen never gives you the answer

The Patient Simulator's display never prints the rhythm name anywhere on screen, in the same way a real bedside monitor doesn't diagnose the patient for you. A trainee has to read the waveform itself: rate, regularity, P-wave relationship, QRS width. That's the actual skill ECG training is supposed to build, and it disappears the moment a simulator labels the answer for you.

Arrest rhythms alarm because of what they are, not just a number

Asystole and ventricular fibrillation trigger the alarm directly from the rhythm itself, not only from a threshold check on the heart-rate figure. That matters because a flatline sitting quietly behind a heart-rate dial left at a normal-looking number is a realistic way for a simulator to fail silently. The Patient Simulator's arrest rhythms alarm regardless of what any other dial happens to be set to. That same blind spot is what makes PEA so easy to miss and so hard to teach.

Mixing up atrial fibrillation and flutter? AFib vs atrial flutter on the ECG puts both side by side on ECG paper.