Shot to the Heart

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

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 generally a very bad idea and almost never practiced by medical personnel. The one exception is traumatic cardiac arrest; while cardiac arrest due to a non-traumatic cause is managed with CPR, traumatic arrest is sometimes managed with thoracotomy. Thoracotomy is a surgery that exposes the heart for direct cardiac massage, and epinephrine can be injected directly into the heart at this time. Intracardiac injection was practiced for nontraumatic cardiac arrest throughout the 1960's, but use declined in the 1970s as better forms of rapid vascular access were developed. In addition, intracardiac injection risks damaging a coronary artery and requires a pause in chest compressions.

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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Examples:

Anime & Manga

• Aria the Scarlet Ammo: Kinji uses this to resuscitate Aria after she loses her duel with Riko.
• 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.

Comic Books

• 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.

Fan Works

• Danganronpa: Memento Mori: The killer of Chapter 5 turns out to have tried applying adrenaline through a stab to the victim's heart after the latter fell unconscious. In stark contrast to how the scenario usually goes in fiction, they end up inadvertently killing them.

Films — Live-Action

• 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.
• American Boy A Profile Of Steven Prince: This unreleased Martin Scorsese documentary from 1978 consists of anecdotes from the eponymous Prince, a former drug addict and roadie. He recounts saving an overdosed woman's life by injecting her in the heart with adrenaline, using a marker to mark the spot to plunge the needle. It's widely believed that the famous depiction in Pulp Fiction was lifted whole cloth from this film.
• Waking Life features a scene in which Steven Prince recounts the real-life anecdote he'd previously told in American Boy: A Profile of Steven Prince and which inspired the famous shot-to-the-heart scene in Pulp Fiction.
• 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.
  • For a chemical weapon that among other nasty side effects melts your skin off.
• 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.
• In Twilight: 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.
• Resident Evil: The Final Chapter: Alice is knocked unconscious by a Booby Trap and wakes up in a dark room where a nasty-looking man is about to stab her with a syringe. Things are understandably tense until the man reveals he was actually trying to revive her with an adrenaline shot.

Literature

• Averted in The Sign of Fear by Robert Ryan. When an elderly Sherlock Holmes collapses of a heart attack, Dr. Watson gives him a misting vapour of nitroglycerine, followed a dose of atropine. He's heard of the use of adrenaline but knows you have to be exact with the dosage, and Watson is working on the floor of his house, not in a surgery.
• In Maximum Ride's Fang novel, Max, who is Afraid of Needles, stabs one into Fang's heart after he dies from a reaction to the sedative. He survives.
• In the Cal Leandros novel Downfall, Cal needs a large adrenaline injection in order to use his Auphe powers and suggests a Shot to the Heart. Robin helpfully explains exactly how much of a bad idea that would be.
• Done in Six Wakes by Captain Katrina de la Cruz to her comatose older clone, killing her via cardiac arrest. Justified as Katrina doesn't care at all whether the clone survives (and would really rather she didn't), and only needs her awake long enough to answer one question - though the answer turns out to be a Red Herring. Despite the tricky legal ground, Katrina is immediately relieved of her duties and brigged for murder.

Live-Action TV

• Star Wars Expanded Universe:
  • Andor: At the climax of the Aldhani arc, the heist crew blasts off in a stolen freighter, and the g-forces cause an unsecured trolley of credits to roll into and crush Nemik, the only person who can guide the freighter through the meteor shower they're using to cover their escape. As Nemik starts fading, Vel stabs him in the chest with a brutal-looking 'med-spike', returning him to consciousness and lucidity long enough to do the deed — which makes Cassian demand to know what she just injected him with, implicitly because given how badly he's injured anything that can revive him like that can only be damaging him even further.
• 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 the third 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. Every human being is different!
• 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 Villain of the Week'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.
  • This is not necessarily the case. While Chicago may or not allow this, Pericardiocentesis is allowed protocol in numerous states and cities, including the City just north of Chicago, Milwaukee.
• In the pilot episode of Treadstone, John Bentley is given a sedative by the Mad Scientist who's brainwashing him, but he's able to escape and make it to a treatment room where he stabs his thigh with an adrenaline auto-injector as he's on the verge of passing out.

Music

• 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.

Video Games

• ANNO: Mutationem: Alluded in the Flavor Text for the Digitalin, it can be taken orally, most users wrongly inject it by force onto the heart.
• In the Call of Duty: Modern Warfare 3 mission "Persona Non Grata", Yuri has to do this to a severely wounded Soap in between fighting off Makarov's soldiers.
• In Tales from the Borderlands, after Vaughn is shot with a Static Stun Gun his entire body becomes immobile for several hours which also prevents him from blinking. Upon meeting with Cassius, Vaughn is immediately stabbed with a syringe and is revived, albeit being heavy dehydrated.
• Battlefield:
  • 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.
• Kane & Lynch: Dead Men has the player or an AI controlled teammate do this if a character is downed. It can be done any time, but do it too often and the character overdoses and dies.
• 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.
• In Left 4 Dead 2, the first person animation for administering an Adrenaline shot seems to play it straight with a downward jab towards the chest, though in third person the Survivors are seen injecting themselves in the leg instead.
• 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.
• In South Park: The Fractured but Whole, The Coon/Cartman, after rescuing Super Craig/Craig Tucker 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. When Toolshed/Stan derisively asks the Coon where he even got the syringe to begin with, he simply says "online".
  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!
  Toolshed: Where the fuck did you get that, Cartman?
  The Coon: Online. Super Craig, just stay still. You've suffered a lot. You guys go ahead, I'm just gonna try and stabilize him.
• In Judgment, the final boss stabs himself with an adrenaline syringe to pump himself up for the second phase of his fight.
• PlayerUnknown's Battlegrounds has an adrenaline syringe available in airdrops and now very rarely spawned. It is a much more potent boost item than the painkillers or energy drink, and fits this trope because the usage animation appears to be your hands stabbing you in the chest with it.

Web Original

• 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.

Western Animation

• In Final Space, after Gary consumes an object that puts him into a huge Mushroom Samba, Avocato snaps him out of it by stabbing a syringe into Gary's chest.
• Rick and Morty:
  • In the episode "Rixty Minutes", 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).
  • In "Rattlestar Ricklactia", after Morty is poisoned by a herd of killer snake robots, Rick resuscitates him by stabbing a syringe into his chest.
• In Big Mouth, the Shame Wizard does this to a worn-out, heavy-sleeping Hormone Monster as a wake-up call that Andrew's relationship with Lola has turned very toxic.

Real Life

• Steven Prince, a friend of Martin Scorsese and former drug addict and roadie, claims that he did exactly this to an overdosing woman and saved her life. He told his story to Scorsese on camera in a series of interviews that Scorsese turned into a documentary in 1978 but never widely released, causing the story to remain obscure until many years after its adaptation in Pulp Fiction.

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You give tropes a bad name...