Huh. I don't remember that being there.
"Zoe flat-lines and gets the Adrenaline-in-the-Heart treatment. Mal follows suit with the self-administered Adrenaline-in-the-Heart. (Medical note — Records show this is becoming televised treatment of choice as it was also applied in the second season's première of Alias)."
— Two Evil Monks
, Recap of "Out of Gas" from Firefly
We've all seen it before. The patient is going into shock, he's losing consciousness! His heart's stopped, and the paddles
aren't working. He's not going to make it! Only one thing left to do. Shot to the heart, stat! His heart's beating; he's stabilizing. Crisis averted!
Shot to the Heart is when an injection of adrenaline is administered directly into a patient's heart, usually by a forceful stab. This can be done for a number of reasons, usually to restart a stopped heart or to restore or maintain consciousness. If the injured person is particularly badass
, he may even do it to himself so he can stay conscious long enough to save the day.
The trope was made popular by 1994's Pulp Fiction
, when hitman Vincent Vega does it to save the life of Mia Wallace, who has OD'd on heroin and also happens to be his boss's wife. Today it's right up there with a tracheotomy
when you need some drama
, but in reality, this is a very bad idea
and a good way to kill your patient. While epinephrine (adrenaline) is used to treat several ailments from anaphylactic shock to cardiac arrest, no doctor since about 1990 would ever
treat a patient by stabbing them in the heart with a giant needle. In the past, an intra-cardiac injection was
used very sparingly, but only by trained medical personnel, only if the heart was completely
stopped and only if every other option was exhausted. In a modern hospital, if you need a drug to get to the heart quickly, it goes into a vein, with chest compressions used to move the blood in the event of cardiac arrest.
In spite of this, it remains a popular trope, especially in medical dramas and grittier
action films, though subversions
and lampshade hangings
are starting to show up in comedic works.
A subtrope of Artistic License - Medicine
. Compare Healing Shiv
. See also Instant Drama, Just Add Tracheotomy
and Magical Defibrillator
for similar use of emergency medical procedures for drama.
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Anime and Manga
- While no needle of drugs is involved, a scene very much in the spirit of this trope that is actually more or less medically accurate occurs in the very first chapter of Saijou no Meii. The title character and a friend are out on a fishing boat when the other boy trips and strikes his chest on the prow. Minutes later he's complaining of severe chest pains and collapses on the floor. A quick cellphone call to Saijou's doctor friend has the boy diagnosed with traumatic cardiac tamponade, and a sudden storm blowing in means that the doctor can't make it to them in time, leaving it up to Saijou to take the nearest sharp object and try to pierce his chest to relieve the pressure without stabbing too far and skewering his heart.
- In an issue of Batman: Legends of the Dark Knight Joker ends up near death after accidentally getting a dose of his own poison. He has also planted a bomb somewhere, so saving his life is actually warranted to find it. One of the first things done to him in the hospital is an injection of adrenaline straight into the heart. He flatlines, is resuscitated by the help of a Magical Defibrillator, and then gets a second shot of adrenaline to the heart, which actually does revive him this time.
- One arc of The Punisher has Frank rescue a mafia don from a South American prison camp by firing a syringe into the don's heart via sniper rifle, firing a sarin grenade into the compound (the syringe was an antidote), injecting himself in the heart, and dragging the don out. If you're wondering why Frank is pulling a criminal out of the clutches of other criminals, he spells it out at the end, when the don is reunited with all his captains, underlings, and anyone remotely important in a single room... then Frank shows up, M60 in hand.
- As shown in the page image, in Pulp Fiction, Vincent does this to Mia, since they don't want a drug lord's wife going to the hospital with an OD. In reality, she almost certainly would have died unless 911 was called. The epinephrine may have restarted her stopped heart, but it would do nothing about the heroin still in her system, and she'd probably be tachycardic from the epi. The primary cause of death in a heroin overdose is respiratory failure; the heart only stops when the brain dies due to the lack of oxygen.
- In The Rock, Nicolas Cage does the self-administered version to counter the effects of poison gas. At least he uses the right drug. Rather than epinephrine, he injects atropine, which along with pralidoxime and possibly diazepam is the correct treatment. Just not directly to the heart.
- In Get Him to the Greek, Russell Brand injects Jonah Hill's heart with an adrenaline shot. Well, Brand's character tries to do a heart injection, anyway. Being high at the time, he winds up putting the injection somewhere in Jonah Hill's shoulder.
- In Sherlock Holmes: A Game of Shadows, Holmes invents an epi-pen. Watson later uses it to revive him after his heart stops from blood loss.
- Variant: In Breaking Dawn, Edward injects vampire venom directly into Bella's heart in an attempt to save her life after a difficult childbirth.
- After falling comatose, Nancy is woken up this way in A Nightmare on Elm Street (2010).
- Done unsuccessfully to Alex Murphy in RoboCop (1987). The trauma team administers a round of intracardiac epinephrine, along with several attempts at defibrillation, in a last-ditch effort to save the dying cop on their table. He dies anyway, prompting his Emergency Transformation into the titular cyborg. Justified in that intracardiac epinephrine was still in use when the film was made.
- Angela kills a police officer this way (the syringe was just filled with air) in Sleepaway Camp III: Teenage Wasteland.
- Almost done in the comedy Senseless. Tim is a medical student who thinks Darryl might be ODing on heroin. (He's not.) Still doesn't make sense; if Tim's far enough in his studies, he should know it won't work. If he's not that far, then he shouldn't be trying.
Live Action TV
- The song "Kickstart My Heart" by Mötley Crüe was supposedly inspired by Nikki Sixx being revived by an adrenaline shot to the heart after almost dying of a heroin overdose.
- At one point in Modern Warfare 3 you need to press X to do this to Soap.
- Battlefield: Bad Company forgoes the usual Regenerating Health for an auto-injector that refills Marlowe's health when he stabs himself straight in the chest with it. The auto-injector always refills his health to full and replenishes itself after a relatively short time, making it a wonder why medical technology continues to exist in the Bad Company universe.
- Battlefield: Bad Company 2: Vietnam, instead of giving you a Magical Defibrillator, gives you a mystery syringe full of chemicals capable of reverting cardiac arrest. Given that it's a game, a shot to the big toe is just as effective as a shot to the heart.
- During the infamous Cold-Blooded Torture sequence in Grand Theft Auto V, Trevor will administer a shot of adrenaline straight to Mr. K's heart if the player administers so much punishment that it causes his heart to stop.
- Reviving another player in Resident Evil 6 shows a short sequence of you kneeling by their side, then stabbing them in the chest with... something. Whilst they're still conscious. It's never made clear what's being used - it could even possibly be an empty fist being punched into the chest in a very misguided attempt at CPR. Again, on a conscious patient able to call for help.
- People with beesting or food allergies generally keep an emergency kit with an epinephrine autoinjector, but it is administered to the thigh or buttock, definitely not into the heart.
- Epi-Pens are also essentially spring-loaded, so there's no syringe involved. It's large and strong enough to go through clothing.
- A constant reminder to soldiers during NBC (Nuclear, Biological and Chemical) warfare training: Do NOT inject yourself or anyone else in the heart.
- Injecting potassium directly into the heart is one way that veterinarians euthanize small sedated animals, as it swiftly halts heart contractions.