Batman: Legends of the Dark Knight #200: A Medical Review, part 2 (The Joker)
The Joker has planted three bombs in Gotham City. The first was collapsed a building, sending hundreds of people to the hospital. The second bomb was defused in the nick of time by Batman. The third bomb is still out there somewhere in the city.
Batman appears in the Gotham General Emergency Room carrying an unconscious Joker. During the battle, the Joker accidentally inhaled his own Smilex and has collapsed. Batman needs him revived as soon as possible to reveal the location of the third bomb.
Dr. Koslowski (narrating): Dr. Singh decided to inject 5ccs of Adrenalin directly into the Joker’s heart. It was our only chance to save thousands of lives.
Injecting medication directly into the heart, despite what you may have seen in Pulp Fiction, is not a good idea. It’s too easy to lacerate a coronary artery (causing a massive heart attack) or inject the medication into the heart muscle (causing a fatal arrhythmia). It’s not done anymore.
Medically, we don’t call it “Adrenalin” in the United States, but instead use the term “Epinephrine”. That’s the third British medical term showing up in Gotham Central ER — definitely a British writer.
Speaking of Adrenalin, 5cc is too large of a dose.
Dr. Koslowski: At which point the Joker flatlined.
So what does the medical team do? They defibrillate him.
Once again repeat after me: Do not shock a flatline. It is a bad idea. It may work in comic book (like it does here), but in real life it doesn’t work and may actually make the situation worse.
Batman figures that the Joker’s abnormal physiology is messing with the antidote and the adrenalin, which caused him to develop an extremely high blood pressure and suffer cardiac arrest. Batman decides to lower the Joker’s blood pressure with medication and then try the treatment a second time. (No criticism here: it’s as good of an idea as any.)
Once again, the Joker suffers a cardiac arrest . This time, Batman himself jabs the Joker in the heart with a syringe full of Adrenalin. The second time’s a charm and it works! The Joker returns to consciousness and promptly escapes…which was all part of Batman’s plan; he wanted to trick the Joker into leading him to the third bomb.
Let’s count the medical errors in a mere eight pages: the Joker flatlines and is subsequently defibrillated, not to mention injected twice directly in the heart with an overdose of Adrenalin.
Note to self: Do not seek emergency medical care in Gotham City. Hold it until you reach Metropolis.
Medical criticism aside, Batman: Legends of the Dark Knight #200 is a good story. I like the idea of a night in the Gotham General ER told through the eyes of an intern, and the story handles this aspect well. I’d like to see more of Dr. Koslowski and Gotham General.
August 25th, 2008 at 11:36 pm
Injecting medication directly into the heart, … It’s not done anymore.
Out of curiosity, what do they do in these situations?
August 26th, 2008 at 7:08 am
Rule one of medicine in Gotham: what should work, doesn’t. What shouldn’t work, does.
Rule two of medicine in Gotham: Doctors in Gotham don’t get to change rule one.
August 26th, 2008 at 7:24 am
Yes, wait til Metropolis, where Superman will keep your heart beating with his heat vision. And doubtless give you an overdose of x-rays at the same time.
August 26th, 2008 at 7:59 am
I thought Joker was completely immune to his own toxin? Must be one of those “varies by writer” things.
August 26th, 2008 at 8:30 am
“Gotham General” might actually make for a great “Gotham Central”-type series. They could even combine the two into one for a “Third Watch: Gotham” kind of thing.
Unlikely, perhaps, but not a bad idea.
August 26th, 2008 at 8:31 am
Official Comment
Johnny B,
Ideally, you’ll have an IV line in place and can inject the epinephrine that way. Some medications, including epinephrine, can be given down an endotracheal tube, but that does take a larger dose.
If you don’t have an IV line or endotracheal tube…then you best get one fast.
August 26th, 2008 at 1:49 pm
Thanks, Scott! Learn something new every day.
August 26th, 2008 at 3:21 pm
Shot to the Heart was done on the Sci-Fi show Firefly too, (”Out of Gas”)
August 26th, 2008 at 3:42 pm
Nick F: Yeah, but you cannot treat the medicine in Firefly (cca 23rd century or so) the same way as in Batman, which is supposed to take place (or time) just about now. I remember reading serious theory about gun shot inoculation in Firefly :)
August 26th, 2008 at 6:00 pm
—–Note to self: Do not seek emergency medical care in Gotham City. Hold it until you reach Metropolis.—–
Laughed so loud that I startled my dog, out of a dead asleep.
August 27th, 2008 at 7:26 am
Of course, given this is Batman, it’s also entirely possible that the entire ER scene was faked for the benefit of the Joker, who was going to revive on dramatic license anyhow.
We had an article at work recently about the “automatic defibrillators” being installed and indeed, they tell you to use it in the case of no pulse. Admittedly, a) the layman might mistake weak or intermittent pulse for no pulse and otherwise might forgo treatment when he ought to and b) I’ve heard that these automated machines actually do have routines for trying to stimulate the heart, not as good as the proper treatment but again better than nothing.
August 27th, 2008 at 6:48 pm
It’s also referred to as “adrenaline” by non-medical folks, so the writer could just as easily have been an American, but one without medical training.
August 28th, 2008 at 10:17 am
>I thought Joker was completely immune to his own toxin? Must be one of those “varies by writer” things.
I was wondering that myself…
August 28th, 2008 at 4:37 pm
[...] …for rigorous medicine applied to that often non-medically-rigorous venue, the comics. The most recent example, quoted at length (and there’s more at source — I trimmed it a little): [...]
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