“Yeah, but…”

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.”

“Yeah, but…”


  1. You’re right and I agree. But he’s right too. Assuming he is basing his answer on the 2010 ACLS guidelines. I’m going to give him the benefit of the doubt. That’s most likely a mistake on my part. Now the part where I wail about the dumbing down of the program … ok im done.

  2. “I know that atropine doesn’t work on heart block, and you know that, but the AHA apparently doesn’t know that; so since this is an ACLS class, I’m going to give atropine.”

    Then again, if his secretary is starting an IV, it’s not like this is an ultra-realistic scenario. 🙂

    As with tpn taxi, I’ll try to limit my wailing and gnashing of teeth about the way AHA classes are designed.

  3. You’re both right, as am I, as is Dr. Endoscopy.

    In the end, I don’t really care what the doctor wants to do, I just want to make sure he doesn’t accidentally kill my mannequin.

    And I want to keep cashing those checks.

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