After injecting the local anesthetic bupivacaine 0.25% for post-op pain relief, the surgeon reached for a suture to close the wound. But 60 seconds after the injection, the anesthesia provider alerted the team to an ominous development: profound and deadly changes evolving in the patient's cardiac rhythm. With a potentially fatal myocardial event unfolding in front of their eyes, the surgeon flung aside the suture and ripped off the drapes while others called for help. As the code cart crashed through the OR door, monitors began alarming: BP 63/30, ECG V-Tach, then a full cardiac arrest. Advanced cardiac life support (ACLS) was started, and the patient left the ASC for a nearby hospital with chest compressions in progress.