I’m doing an ACLS check-off for a group of physicians as part of their biannual renewal. It is some of the easiest work I have ever done, and I have a blast doing it.
I give the delightful gastroenterologist his scenario, a middle-aged male who is waking up from his lower GI study. He doesn’t feel good, and it is only going to get worse from here.
Doctor Endoscopy asks for a set of vitals, and learns the patient is hypotensive, bradycardic, with pale, diaphoretic skin, and very weak.
“Okay, I want to put him on the cardiac monitor.”
“Sure thing. That’s what you get when you turn on the monitor” I say, as I press the button on the rhythm generator that hints it will display something resembling a a complete heart block.
“That is a third-degree heart block. I need someone to start an IV, and put the pacing pads on him.”
“Okay, your secretary has started an IV, and the janitor has applied the pacing pads.”
“Okay, I want to give point-five milligrams of atropine.”
“Are you sure?”
I pause the scenario, as best as a scenario can be paused. “Um, atropine isn’t going to work in a complete heart block.”
“Well, I’m the doctor, and that’s what I want to give.”