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this post was submitted on 11 Feb 2024
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Any idea what kind of health complication causes blood to gush from your nose and mouth? Sounds insane to watch especially when you can't leave the immediate area...
Critical care nurse here. The answer is esophageal varices.
It's the same physiological anomaly as hemorrhoids, except in your esophagus. Swollen, fragile veins caused by increased internal pressure. In the case of hemorrhoids, that pressure inside the veins is caused by straining too much when trying to poo. In esophageal varices, the increased pressure inside the esophageal veins comes from blood backing up from a swollen, scarred, and damaged liver. So we often see esophageal varices in end stage alcohol use disorder.
Horror stories abound in emergency departments and ICUs of having to do CPR on a patient massively hemorrhaging out of their mouth from esophageal varices. As soon as nurses I know saw this report, our immediate thought was, "Yep, varices."
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
I’ll take “Reasons to never drink again for $200, Alex.”
There are a few things I wish we could really show the public. The first is how brutally savage and undignified CPR really is. And the second is what alcohol abuse really does to a person.
Chronic malnutrition, brain damage, hallucinations, anxiety, internal bleeding, fluid swelling your abdomen like a water balloon, literal ammonia building up in your blood that we treat by deliberately inducing massive diarrhea. That's not even mentioning esophageal varices and the increased cancer risk.
Alcohol is a horrifying drug.
I scream, “break the ribs!” every time I see movie CPR haha
And then the movie patient pops up and smiles and everything is perfectly restored back to normal instead of, "Oh, we convinced your heart to start beating again, but you're still unconscious probably because you have brain damage, your kidneys are dying, your blood is acidic, and now we're gonna put you on a breathing machine. Best wishes!"
My wife and I have both taken CPR classes together. She has very strict wishes about when I should render aid to her. Basically there has to be a 90% chance of an almost instant full recovery before I'm allowed to help her at all if something goes wrong. She knows the risks and so do I. I'm supposed to give her up so I don't let her down.
Hands down the best comment I have ever read. The subject. The setup. The payoff. The layers. Genius.
We are not worthy. It’s downhill from here. Just… perfect!
I am from the internet. I'm here to help.
I was really readying a polite, "No you should definitely render aid first and ask questions later" lecture until your comment made me read that again...slowly.
That setup was subtle and very well done. Bravo @FauxPseudo@lemmy.world
Are you able to make the determination, or just haven't taken a CPR class?
I ask because that's a lot of pressure put on you, to try to make that kind of emergency diagnosis, especially if you're not in the medical profession.
I believe they’re thinking of a full commitment that you wouldn’t get from any other guy.
There are two things my wife wanted me to know when I started dating her. The first was that she was polyamorous. And the second was that she has always wanted to be dead. That last one has changed over the years she has known me. But the CPR class didn't educate me on the risks of CPR. That I have learned from other sources. I know eventually this will result in cops and lawyers to cause me problems. But she is still very firm on the idea that it should never render aid to her unless it's going to be a quick fix. She cannot stand the idea of being a burden to anyone.
Make sure she gets an advance medical directive. I keep forgetting to set one up, but basically you can say when you can be revived, etc
I'm still intensely proud of myself for the one time I caved a guy's sternum in and he woke up to complain about it.
I was an ER tech at the time and he coded in CT (it's always in CT). So there was a nurse riding the gurney doing compressions while they brought him to the resuscitation bay where I took over compressions. I cracked his sternum on the third compression because, despite having about 75 pounds on me and being on top of the guy, the nurse hadn't cracked a rib or gotten perfusion. Unfortunately, someone had lost the CPR stool in the resus bay, and I was the only person tall enough to do compressions, so I did it for the full 11 minutes or so of the code in full isolation gear (because Covid). On the second round of amiodarone and defibrillation, he woke up and started fighting the tube that had been placed a few minutes prior. The first thing he said when he came to was that his chest hurt.
He was awake and talking to his family a couple hours later when I took him up to the ICU after all the admission paperwork and whatnot was done.
Why is it always in CT??? That's an incredible save, if the first round of compressions weren't really effective. I can't even imagine doing compressions for 11 minutes at all, let alone in isolation gear. I think I'd join the patient, if I tried that.
I was sweaty as heck and completely winded by the end of it, but the notion that you are currently responsible for a person's life and brain with their family in the hallway outside makes for good motivation.
And yet everyone looks at me funny when I see the same and yell "sweep the leg!"
If you aren't breaking ribs you aren't even trying. Likewise if you aren't sweeping the legs I have to doubt your comment to Sparkle Motion.
There was a recent video I saw where whatever they were using for a body visibly collapsed to dramatize the broken rib thing, and it was horrible to watch. Maybe SkyMed?
I'm a 911 dispatcher, I've talked people through CPR countless times over the phone, I have very little confidence that most of them were doing it properly because CPR really is pretty brutal, I've taken a lot of CPR classes over the years, and every instructor I've ever had has mentioned that if you're doing it right there's a very good chance you're breaking ribs in the process. Unless you've actually had training and have an idea how rough it can be I doubt that most people are going to do it hard enough out of fear of hurting the patient.
I've luckily never had to do CPR in person myself, although I was once on-scene while it was being performed. I was at a party, someone came inside said they think someone died out front, I went out to see what was going on, came around the corner of the driveway and my friend was already doing CPR on a guy laying in the street who crashed his motorcycle. I know my friend also had CPR training so I let him keep at it, I stood by to relieve him in case he got tired and started counting to make sure he was keeping a good rhythm. I of course know my share of cops, firefighters, EMTs, etc. who have had to do CPR in their line of work, but I don't exactly press them for any details about it, but I talked to my friend afterwards to make sure he was OK, and he talked about how he could really feel the guys ribs popping as he was doing it.
It was also a pretty good illustration of the bystander effect, when my friend got outside there was already one or two other people pulled over with the accident but not really doing anything, not checking on the guy, not on the phone with 911, just kind of standing there. If you asked them, I'm sure they probably would have said they were blocking traffic with their vehicles or something, but that doesn't really do any good when the guy needs CPR immediately.
My wife's aunt died from Cirrhosis of the liver and "so much blood" is exactly what my wife said she saw.
Just another reason I’m glad I don’t care to drink alcohol… did not know this was even a thing 🤢
Good question. Gasses certainly expand significantly when ascending to the roughly 5000' cabin pressure altitude.
Which is readily apparent as the cabin quickly fills with farts. Yes, that's a thing.
Dissolved gasses in the bloodstream will also be affected by this, though not quite as drastically. Still a thing a though. That's why you don't get on a plane (or even hike above 500m) within 24 hours after you've been scuba diving.
But if you accidently do, or it's an emergency and you need to fly, at least for some flights you can ask the flight crew to raise the cabin pressure so you don't get bent.
So all that said, yes, it certainly could be a possible contributing factor.
Well that is pretty horrific
The only time I see ER docs panics and asked for another ER doc to be on "stand by" for emotional support is when they need to change a leaky Blakemore tube.
You know it’s a been a bad day when you arrive to your shift and the Blakemore box is out…
I forgot the medical term but when you have a REALLY bad liver the blood starts to take other ways to the heart to circumvent it (kollateral paths).
One path is going through your oesophagus so your venes widen very much. With the widening the risk of a rupture starts to increase very much and as soon as it does, there is nothing much that can save you.
I am not saying he got that but the description fits very much on point.
The word you're looking for is esophageal varices
Obviously I doubt this but it's a final phase of ebola.
Nah ebola is more of a oozing bloody mass. Gushing isn't possible because low blood pressure is another complication. Also, late stage ebola this man wouldn't be walking anywhere. Let alone well enough to be allowed on a airplane.
Disseminated intravascular coagulation, it's when you get a bunch of clots, that uses up all your platelets, and you bleed out because you can no longer clot.
This wouldn't explain what caused the bleed in the first place, nor how rapidly and profusely they were bleeding. Esophageal varices is a better explanation
Yeah, your explanation is probably a better one.
For real, I need a plausible explanation
Check the comments again, seems like we got it 🙂
Ebola virus?
Oddly enough, alcohol abuse. It’s called esophageal varices.
It’s basically caused by veins in your esophagus rupturing. The same way you can have veins hemorrhage near your anus, causing hemorrhoids. In your esophagus, it’s usually caused by an enlarged liver putting pressure on the surrounding veins. And an enlarged liver is usually caused by end-stage alcoholism.
So the dude had an enlarged liver, (likely sue to a lifetime of alcohol abuse,) popped veins in his esophagus, and started coughing up massive amounts of blood. The dude likely wouldn’t have survived even if he was sitting in an ER when it happened. By the time it happens, it’s usually too late to fix; The victim will drown in their own blood before doctors have a chance to fix it.
But as a random onlooker with no idea what’s happening, it’s absolutely horrifying to see. It looks like something straight out the beginning of a zombie movie. Hell, even if you know exactly what’s happening, it’s still horrifying to see. But at least if you recognize it, you know it’s not contagious.
Source: Dated an EMT for a while, and she had a patient deal with one right after we started dating. I got morbidly curious, and regret the ensuing google searches.
I want to know too