"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)."And you're to blame... 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 (clinically termed epinephrine) 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 or determined, 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 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. Not to be confused with shooting someone in the heart with a weapon.
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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 real life, one of the primary treatments for heroin OD is a large injection of naloxone, which temporarily reverses respiratory failure caused by opioid overdose. But, like epi, you slam naloxone into a vein or a large peripheral muscle and very much not into the heart.
- 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
- Done twice in the Firefly episode "Out of Gas."
- Simon administers one to Zoe after she's injured in an explosion.
- Mal stabs himself to stay conscious after he is gut-shot.
- Clark does this to Chloe in second season Smallville episode "Truth".
- On The Big Bang Theory, Sheldon tries to prank Howard with an Electric Joy Buzzer, but Howard appears to collapse from a heart attack and is instructed to stab a syringe of adrenaline straight through his heart. It all turns out to be a counter-prank.
- In the season 1 finale of Nikita, Amanda does this to revive Alex after killing her with the Kill Chip. It was the only way to set her free...
- Doc Robbins does this in one CSI episode, where a guy revives on his table.
- Happens in the Stargate SG-1 episode "Avatar," in which Teal'c gets trapped in a virtual reality training program that shocks him every time he dies to increase the realism. The doctor monitoring him has to administer an adrenaline shot when his heart stops after dying for the umpteenth time.
- Mostly averted with House. They frequently resuscitate people with epinephrine, but it's usually administered through the patient's IV line.
- Parodied in Time Gentlemen Please, with a scythe instead of a syringe, and a strong spanish beer for adrenaline.
- Parodied in 30 Rock when Don Geiss goes into a coma.
Jack: "Can't you just inject something right into his heart?"Dr. Spaceman: "I'd love to but we have no way of knowing where the heart is."
- Happens on Downton Abbey - though it's 1912 and this is a new and relatively unusual treatment, and thus Isobel has to go behind the stuffy, snobbish Dowager Countess's back to get the doctor to try it on a patient who would otherwise die.
- Emergency! liked this trope, although it was usually done through the patient's skin and muscle, rather than right into the heart with the chest open. This was Truth in Television for some situations in the 1970s, however - all the procedures and treatments performed by the paramedics were taken directly from LA County's EMS protocols at the time.
- The paramedics themselves never did a shot directly to the heart; they always administered meds through the IV. The direct heart shots were always done properly by the doctors in the ER, after everything else failed, and were also shown to not work. If a situation hit the point where the docs did the shot to the heart, you know the victim's not going to make it.
- Person of Interest. In a Who Dunnit To Me plot, the POI has been fatally poisoned, and as they're driving to the Big Bad's house, says he just wants to live long enough to look his murderer in the eye. Shortly after, the man in the back with the POI shouts that he just died. Reese pulls over and injects the POI in the heart, keeping him alive long enough to confront his murderer (and witness his Karmic Death).
- In the case of Chicago Fire where a patient is suffering from cardiac tamponade (blood/fluid collecting in the pericardium), Paramedic Dawson performs pericardiocentesis in the field, draining the fluid from the sac encasing the heart and saving the patient, but accidentally puncturing the heart muscle in the process. While this intervention and even the outcome is pretty realistic, no medic liking their job would attempt such a thing.
- 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.
- In South Park: The Fractured but Whole, The Coon/Cartman, after rescuing Craig from a large rift of "lava" (red Lego bricks), produces a real syringe with real drugs out of nowhere and forcefully stabs Craig in the chest in it. Given that the whole superhero jig and everything involved with it is a (mostly) harmless roleplay, Craig is quick to call Cartman out on this, lampshading the Real Life ramifications of the trope in the process:
Super Craig: What the fuck was that, you asshole?!The Coon: It was an intracardiac injection, Super Craig, I had to stabilize you.Super Craig: Are you fucking serious right now?! You could have fucking killed me!
- When Toolshed/Stan derisively asks Cartman where he even got the syringe to begin with, he simply says "online" which foreshadows his ultimate role in the story.
- In the Rick and Morty episode "Rixty Minutes", we see an alternate universe Jerry who never married Beth and became a super-famous actor (if the movies we see in this universe are any indication, Tom Hanks levels of famous actor). At one point, we see this Jerry on copious amounts of several substances, including a hypodermic needle sticking out of his chest (indicating this treatment was done to him off-screen).
- Conversed on a web page Two Evil Monks. In their snarky yet affectionate MST-like commentary, they inform readers that records confirm that administering Adrenaline-in-the-Heart is becoming televised treatment of choice. It's a part of their picture spam recap of the Firefly episode "Out of Gas" and the episode "The Enemy Walks In" from Alias. See two screen grabs and the commentary at top of the page.
- SF Debris: Conversed by SF Debris while reviewing and MSTing Firefly's "Out of Gas". Chuck says that you really shouldn't take medical advice from Quentin Tarantino's movies, referencing the famous scene from Pulp Fiction.
- People with severe allergies generally keep an emergency kit with an epinephrine autoinjector, but it is administered to the thigh muscle (self-administration for adults and older children) or buttock muscle (parent-administered on a non-cooperative child), definitely not into the heart.
- Epi-Pens and other epinephrine auto-injectors also use spring-loaded wide needles that are large and strong enough to go through clothing.
- As a final aversion to the trope: Epi-Pen needles are only ~15 mm long. By design, this is long enough to punch through cloth and skin to muscle, but too short to reach someone's heart or anything else inside their ribcage.
- Needle thoracostomy, which is a reasonably common emergency field treatment for a collapsed lung, looks like a Shot To The Heart, in that it involves stabbing a gigantic needle into a patient's chest. However, the needle goes into the upper chest just below the collarbone, never anywhere near the heart, and doesn't contain anything - it's left open to vent excess air out of the chest cavity.
- A constant reminder to soldiers during NBC (Nuclear, Biological and Chemical) warfare training: Do NOT inject yourself or anyone else in the heart. Stick the auto-injector into the thigh or buttocks, instead.
- Injecting potassium directly into the heart is one way that veterinarians euthanize small sedated animals, as it swiftly halts heart contractions.
- Similarly, potassium can be injected into the human heart to stop it during cardiac surgery.