How Low Can You Go?

Beeping monitor alarms are the elevator muzak of the ER: always playing, often ignored after the first refrain.  I've seen many patients impressively hold up their end of the conversation while the monitor read V-tach, and a few patients in actual V-tach without the monitor seeming to notice.  Nevertheless, the beat goes on and I often find myself silencing the alarm from the central monitor on the massively hypertensive patient who hasn't taken his medications for the past two months.  The other night, as I went to silence yet another shrill alarm, I noticed the patient had a heart rate in the low 40s that would brady down to the low 30s every few seconds.  I turned to the nurse, who was already aware, and she said for whatever reason the doc was okay with that.  An elderly fall victim with a heart rate in the 30s would make me a little uncomfortable, but what do I know?