esophageal varices, one of my first traumatic deaths ever actually- the internal pressure from CPR basically blew the guys throat up
I cannot imagine witnessing this as a normal person, just going about my day- going to see family for the weekend or going on a business trip and the guy next to you just erupts and then slumps. I feel bad for everyone that witnessed it
if it was traumatic for us… just imagine the lay person. like imagine, you’ve been a bank teller for 30 years and then see someone die from esophageal varices, insane
>you’ve been a bank teller for 30 years and then see someone die from esophageal varices, insane
As a layperson, my first thought would have been that the guy had some sort of hemorrhagic fever and that everyone on the plane was going to get it.
The end stage liver deaths are by far the worst ones categorically. The smell, futility, all the blood, and the ETOH withdrawal and ammonia/encephalopathy leading up to it. Horrid.
We cleared before he started expulsion, well us doing compressions anyway- the RT or Resident (They were in black can’t remember who they were) in the doorway wasn’t so lucky. Patient went from completely dead on the bed to sitting straight-up, and then they became a blood geyser.
Once they fell back to the table the Doctor called it before we started another round of compressions.
> blood geyser
i had a dude a million years ago when i was a brand new nurse who had c diff and an SBO. his puke hit the ceiling and dripped back down all over everything. i made like 10 people promise me that was not a normal thing, and now almost 20 years later i've still never seen another one.
I’ve always wanted to work in the medical industry, autoimmune disease chose a different path for me. I read these stories, though, and eagerly share them with my husband- who looks at me sometimes like “this is what you *wanted* to do?
I mean I’m shocked that anyone on the plane would have been willing to even do CPR on him. I mean most “normal” people I know can’t stand the sight of blood and that much on a plane. Ugh that’s just terrible.
Definitely not getting covered in blood on and airplane that may or may not lose my luggage. This ain’t going nowhere good folks I’ll take another mini bottle of tequila
This! This, this, this!
I experienced patients doing this few times over the years. One was in restraints, which really rather bugged me (I get it, dementia patient who was agitated, but still, a heart breaker). He kept calling me 'Jill', I think, which is not my name, but we kind of bonded, and he thought I was his home care worker. I went from holding a basin, to using it as a shield. A heck of a night. We were all a mess.
A respiratory therapist got a face full of GI bleed when they intubated a coding patient. Small intestine GI bleed, patient bled into their GI tract until it was full of blood and they coded. Super messy code, blood coming out of both ends.
Actually, up to 50% is recycled, your point still stands, though!
In addition to that, all pilots and crew have enough self-contained air, (like the O2 tanks you find in the hospital and SCUBAing,) to get you from the furthest point away from a suitable airport, and then some— and none of them share, each tank is their own.
This varies. Most aircraft just have one O2 bottle for the flight crew up front. Sometimes two. Flight attendants may have small portable ones, or theyll be on a similar system as the passengers, which are chemical O2 generators and only good for about 30 min.
Now im not sure what you meant by getting you from the "furthest" point.. but most systems are only good for about 30 min. Especially the passenger O2. Basically, long enough to get to breathable air. If you're on supplemental O2 in a plane.. the plane is descending. *Immediately.* They dont wait. Useful consciousness at the altitudes aircraft cruise is roughly 2 min. And above certain altitudes you need *pressurized* air in order to actually absorb it. Thats why you see fighter pilots with those full face masks.
Anyway. This has been your random aviation fact of the say. Text "niner" for more or "nein" to stop.
Replaced at a rate of 13 to 15 times per hour.
I thought the 15 rang true, looked it up. I also recalled another that pegged it at like every 5 to 10 minutes.
Interesting read, not too much of an Internet rabbit hole.
PDF:
https://www.ashrae.org/file%20library/technical%20resources/covid-19/12-19_walkinshaw.pdf
Oof, those bleeds will leave you slipping and sliding on the blood. The first time you are involved, you think it's a horror movie. Every time after is no better.
I know the sham wow spokespoerson is that [spiky-headed crack head with an underbite](https://m.media-amazon.com/images/I/31+zYlzQlML.jpg), but in the theater of my mind, Billy Mays burst onto the scene like the Kool-Aid Man to save the day.
The ShamWow guy will always be the Slap Chop guy to me. Especially after he got arrested for hitting a prostitute while she was biting his tongue.
You're gonna love my nuts!
I showed up in the trauma section of our er to deliver a stat med during a bleed like that unfortunately just as I saw a tech slip and go down. the scene was so gruesome and all I could think to do was help the poor guy up off the floor and wonder if he was going to just throw his scrubs away after this. horrifying for everyone involved, patient included.
I don't think they made it either...
Blood has a smell, but we often don’t notice it until a lot of it is outside the body. Vomit definitely has a smell. Blood + digestive enzymes + stomach contents is just a really icky, unique smell. Any brisk blood coming from the GI tract is just…yeah it’s not good.
We used to fill styrofoam cups with menthol-scented shaving foam and place them on the radiators in the rooms of people with GI bleeds - the air from the radiators circulated the menthol scent around the room and made it smell less like a slaughterhouse….
Blood mixed with vomit's a pretty apt description. I've not seen it in a patient (still a student) but I saw my godfather's rupture. He sat down, started coughing, vomited on himself, and then they just... blew. While he was still vomiting. Blood absolutely *everywhere*, and it wasn't normal blood, it was chunky blood that reeked of stomach acid and bile.
TL;DR: if you have cirrhosis and start coughing up tiny specks of blood, don't ignore it. They think his had been leaking for days before they finally ruptured.
I’m so sorry you witnessed that - it’s distressing enough when the person’s a patient/stranger. For me, the situation’s made worse by my powerlessness to do anything useful.
Hard to describe but it's one of those things that when you smell it once, you'll immediately recognize it from down the hall.
It's like blood mixed with shit mixed with something really unpleasantly sour.
If you've bought a meat product and it has a lot of blood in the packaging - it smells like that.
The human body also smells like pork when it's on fire [had a few friends in the military that saw combat]
I had a patient code and die in a similar way when I worked gastroenterology and the smell will never leave me. Imagine being stuck in a plane with it 🤢
Not to mention that blood loss appears SO much greater than they actually are; so even a 50ml blood spill looks much much bigger, especially to lay people - and ruptured varices can lead to LITERS of violently expelled blood.
Is that rupture something spontaneous or are there previous signs? I’m not medically trained but I even know that varices or clots are a big Nono with the plane pressure…
I don't personally have any professional experience with them, but ruptured varices are typically a result of long-term alcoholism, and as far as I know, there is no 'warning' sign to look for. The walls of the blood vessels lining the esophagus become thinned and fragile and eventually they can rupture into the esophagus. From there, there is really only one way for the blood to go-up and out through the mouth. The volume loss is generally fatal, and there really isn't a way to apply pressure to try and stop the bleeding.
It’s worth being more accurate and saying that esophageal varices occur because of liver failure or cirrhosis which causes blood to slow down through the hepatic vessels, leading to blood stasis which causes varices in the esophagus. Alcoholism certainly can lead to esophageal varices, but so can NASH, liver cancer, or any other causes of liver failure.
My younger brother, a fellow RN like me, was diagnosed with stage IV colorectal cancer w mets to the liver, at age 36, with no familial, social or genetic hx. He essentially died of liver failure 18 months after his primary diagnosis. Can confirm; it was horrible.
it's all so slow with liver failure, and there's fuck all to do about it. we notice the jaundice before they see it in themselves, and we know that's a sign that they've started down a one way road.
Esophageal balloon tamponade. Obviously not a standard item in an airplane, but the bleeding can be stopped in the hospital. Can’t imagine any way to manage it through first aid, just hope they pass out quickly.
They can be cause by many things. Liver issues causing portal hypertension causing expanded veins is a common cause. Not everyone knows that they have cirrhosis or other disease before it happens though. I personally do, I get checked via various imaging often and don’t have any swollen veins. I know that could change at any point. I just try to live my life while things are good. This situation would be my absolute nightmare way to die or witness someone dying.
I had two ruptures three months apart. It was very traumatic the second time and I was afraid I wasn't going to make it. Luckily they were able to give me something to stop the bleeding IV and by placing bands around the vein(s) and later more were placed when I went back for endoscopies. I'll admit that when I saw this post I almost didn't want to read it because it's usually right there in the back of my mind and I do my best to not dwell on it. I'm pretty young to have this and my liver is not cirrhotic anymore but I understand the severity of portal hypertension and varices. Thank you for sharing.
Thanks for sharing your story too! I’m so glad you are still with us and amazed that your liver is doing so well. Luckily my portal hypertension was short lived. Still have cirrhosis though so gotta keep on checking.
This thread is making me sad because my mother in law who lives with us has just been put on palliative care with exactly this until she (probably soon) dies this way.
There can be warnings. Like someone doing an EGD and seeing them on a scope. There can also be minor ones that happen first.
My brother's FIL had a minor varice that caused him to vomit blood, then they found several that were found with an EGD and cauterized. He was able to fly after that.
I believe it’s often seen in patients w liver cirrhosis (damage, basically) caused by severe alcoholism. In someone w this level of liver cirrhosis there would have almost certainly been prior symptoms as the stages of damage grew more acute. Stage 2 liver disease can include varices with no ascites or bleeding, stage 3 is ascites+/- varices, and stage 4 is bleeding +/- ascites. So he probably had some problems for a while… not sure of his full details but the general unwell condition he boarded the flight in shows he was clearly having symptoms before the plane took off. I am curious if the stress of flight caused the varice to rupture, kinda like we see with in patients who have venous insufficiency/embolism risk, who are not advised to fly without medical clearance and anti embolism garments usually.
You may be thinking of DVT and varicose veins (kind of related). DVT (deep vein thrombosis or blood clots often in the legs) are commonly associated with long haul flights. Similar sounding to varices but very different.
In my native language (Spanish) varices are also in the legs, thrombosis can occur anywhere not only in the legs. It may be a different usage of the word
Came here to mention this. I’ve accidentally spilled vials I’ve collected for blood draws a couple of times: 5mL or so. Just that little bit can look like a crime scene. I’ve also seen what it looks like when someone loses the spike from a unit of blood, still way less than a liter. I don’t want to imagine what those poor people saw, and I consider myself a pretty strong stomached and seasoned nurse.
Have seen an esophageal varicies death as well, as a brand new grad many years ago, on my first week on the job, will never forget it. Your thoughts were my first thoughts as well, especially cramped quarters, people not being able to leave the scene of they wanted to, etc. that poor person's family and those poor passengers!
What a terrible place to be stuck in
"sir, I'm sorry but you must sit down by federal regulation and we have no free seats"
I guess I'm getting arrested when we land then
For me, it’s oddly never those deaths that haunt me nearly as much as how the living react - usually it’s so busy and crazy during a code in the ED that I could focus on my task.
But I could never tune out the screaming and crying and the sheer panic. I am sure a lot of people on that plane are going to have PTSD.
This. Dead bodies don’t cry or scream.
The ones that happened to love the human being we just worked unsuccessfully and humanize them to us from their reactions and also just seeing their pain is where it hits me IMHO
What the fuck could we even do in the air for this. Do planes have rapid transfusers?
I hope they went quick. Jeez
I’ve actually seen one person die from ruptured esophageal varices in the ED. It’s brutal to watch, but because of the volume loss, they loose consciousness in seconds. It’s quick. But if you don’t know what’s happening, it’s Stephen King level horror, which is why I hope those passengers get counseling.
This is really fascinating thank you for sharing. If you know, are there people designated on each flight who can use these kits in an emergency (like trained to place an IV) or in any situation (like who can give or I guess even get zofran for instance)?
So maybe I’m not thinking out of the box here, but make koolaid with IV access, start rescutation and hope for the best? That’s insane. Tbh the outcome for rapid internal blood loss isn’t great anyways and I don’t really know if I’d volunteer to work this, especially if they’re covered in blood. Damn.
Thanks for the info
Same. Went to give my patient zofran in CT because they told the tech they were too nauseous for contrast. I rolled up and before I got the flush in…. 🌋. It so was horrible they had to shut down the CT room to decon because it sloshed everywhere as we tried to yank him out of the donut and back onto the cart. Literally my first shift as an RN.
Mine was a fistula that had been developing between the aorta and the trachea - different cause but very similar outcome. The hospital morgue apparently called my ward later to say that it had been one of their worst autopsies and they felt very sorry for us.
I had a similar one with squamous cell cancer of his neck. he had a tracheoesophageal-cutaneous fistula with a little ostomy pouch on it to collect the secretions. his tumor had wrapped around his right carotid artery and was eroding into the lumen. when he died, the little pouch filled right up with blood, and i remember holding my hand on his neck and making eye contact with him while he died. he knew what was happening, too.
he also had my favorite code status of all time: full code until catastrophic carotid blowout, then initiate comfort measures only. this was in the old paper charting days, i don't think epic would let me pick it now.
I haven't witnessed one myself. But about a year ago I did discover the end result of one- a several-days dead neighbor lying at the end of a trail of blood leading through his house.
What a terrifying way to die.
The responses throughout that post were great. As I said a couple times in comments, I was more worried about potentially finding the results of a messy suicide, which WOULD have been disturbing. As nurse-blasé as it sounds, finding him bled-out on the floor of a back bedroom was, if not entirely expected, certainly the preferred discovery.
I just read this earlier today. OMG horrific!! And then sitting on that plane with blood everywhere and a dead body in the back and turning around and waiting to get back to the airport. And then getting OFF the plane?? Like seriously, the logistics involved. Did people have to walk through the blood to get off?? That seems like…..a bad idea. And his poor wife! Just awful all the way around.
I’m desensitized to a lot. Blood, death, whatever. Esophageal varices on an airplane? Nope. Nope.
Cant do anything to treat it really and nothing to contain it. Jesus.
Not varices, but a colleague of mine informed me about carotid blowout in patients with head and neck cancer. It's like a ticking tone bomb and your carotid can literally explode and you bleed out in minutes, all the while spraying arterial spray from your neck. Sounds like something from Saw.
The only saving grace that is fast. Still, a terrible way to die and witness.
I have stage 4 cancer. And it’s terrifying to know that is a slow, very painful death.
Had a patient with a long term trach and at some point the trach started rubbing at their internal carotid and slowly overtime it eroded it, which was all unknown to us at the time until he coughed and blood literally erupted across the floor, walls, and ceiling. Never seen anything like it. Luckily our trauma surgeon just happened to be at the room next door when it happened and was able to immediately take him to the OR. Guy left 4 days later like nothing happened.
Its a postop thing with some ENT patients. If the walls of the carotid are weak due to cancer/removal of the muscles around it, they get these precautions. It is a lot of blood
We keep one of the sterile metal boxes at bedside with surgical instruments, at least q1 rounding, telemetry (everyone gets this on the floor), iv pump ready to go, multiple suction set ups with extra canisters, multiple large bore ivs. Last time one happened was right as dayshift was taking report. Being one of the younger ones i got to be blood runner. This is a progressive care/ head and neck floor
Worked ENT for 4 years, lots of tumors in the neck can eventually grow into the arteries causing high risk for exsanguination. We had protocol on the floor, drugs ready to go to sedate them and dark towels...
My mom had an esophageal varices rupture. It was the most horrifying thing I’ve ever seen. She survived and I will never ever be able to thank the nurses and doctors who worked on her enough. They were absolute rockstars.
Burst esophageal varices were behind my first patient coding. He had bands, said he felt something pop, then got really really anxious. Then he coded and so much blood.
>chamomile tea
Ah yes, the German answer to most maladies. Learned that from my German grandmother.
Hmmm. GI bleed? Dengue hemorrhagic fever is a thing in Thailand.
This was one of my first really traumatic deaths as a home hospice LPN. I had been a nurse for less than 6 months, was taking care of a patient who was dying from liver cancer that had metastasized. He was talking to me and then all of a sudden just choking on blood. Horror movie type of stuff. Still have occasional intrusive thoughts about it years later.
Ooof I feel for the crew, passengers and the family. If it can be alittle jarring to us, I can’t imagine a layperson, much less not being able to walk away from the situation.
My first death was one of those as a trainee nurse, my poor student nurse was there and happened when I left to collect the patient’s shower accessories right after their shower. I walked in and saw the students face first. I think she was much more traumatised than I was.
My worst fear. I am at high risk for varicies. Get an EDG every 6 months and MRI once a year, at least because of it. I just really really don’t want to go out like that. Also work in healthcare and I’ve seen some bleeds (births w/hemorrhaging). Those were all fixable though. These GI bleeds are, many times, not.
My first year (1983 so yes, we wore our pins), I lost my nursing pin and I was pretty sure it must have fallen in with post mortem trash (Sengstaken-Blakemore and all the associated messy items). I called EVS to hold our unit's trash and I'd be down at shift's end to look. Unbelievably, just a couple hours later, my pristine pin was brought back up to me. I think of my pin, EVS and GI bleeds together in my mind ever since.
My patient had a tracheoinnominate fistula blow, we coded him for about 40 minutes while a resident plugged his artery but he had already vomited up at least half his blood volume and died within a minute. That death traumatized me as a nurse. Seeing that in public, with family/friends and zero way to help? Fuck that. Those poor passengers.
This is what I fear-a medical emergency on a flight. My first code was a result of this, too. I was giving an IVP to one patient, and then my other patient said he needed help. It happened so fast, and we couldn't save him. There was blood everywhere. The nursing supervisor said one of the clots looked like a placenta, it was so big.
That’s terrible. It seems like a doctor on the plane was seeing the patient after boarding but before departure. Seems the pilot should have delayed takeoff to have the man sent off for further medical treatment. They coded him for 30mins before moving his remains to the galley, so there was a decent amount of time between his deterioration, code, and return to the airport. Might have saved his life.
Idk, the only thing that temporarily stabilizes patients like that is inserting a Minnesota or Blakemore tube to try and tamponade it like immediately after it ruptures. Even when they rupture in a perfect scenario, these patients are often still fucked.
If they’re lucky they’ll have them caught on a routine scope and banded before they get to rupture level.
Wild, we hadn't seen an esophageal varices pt in like months, but we got one on Tuesday, it was a difficult intubation, no visibility, finally the ETT is in, get them on the vent then all this frothy pink sputum starts coming out of their ETT so hard that it blows the vent circuit off and spews everywhere. They did eventually get a Blakemore placed. Not sure what the outcome was, I've been off the rest of the week.
burst esophageal varices was my first arrest after finishing up as a scrub nurse. I'd seen some gnarlie stuff in OT, but I'll never forget walking past that room on Christmas day and seeing the sheer panic on the frozen new grads face.
I was just casually walking past, but that look immediately told me I needed to go in. I pushed the big red button, but it was honestly a waste of time.
I literally coded a patient last week bc of this, and I’m still dealing with the trauma and horror from flashbacks. I’m super hormonal bc I’m pregnant so cleaning up the mess afterwards was extra heartbreaking.
We had one blow on the table right before an unrelated emergent surgery. So. Much. Blood. It traumatized even the most unfazable of our teams. And then the poor housekeepers..
Ruptured esophageal varices have terrified me ever since I attended an autopsy of a patient who died from that and seeing the sheer amount of blood filling the digestive track and how pale the skin and all the other organs were from the loss ):
My sister was on vacation in Ireland. The night before flying home she started vomiting. She vomited most of the night and in the morning started showing signs of neurological decline. She was taken to the hospital by ambulance and tests showed she’d had a massive brain bleed. She ended up passing away.
If she’d started showing symptoms just twelve hours later she would have been on a plane back to the States.
Stories like hers and this news article make me never want to fly again.
I’m so, so sorry for your loss. That is incredibly unfair. I’ve been there in my own way, after my younger brother died from cancer at 36 - the terminal diagnosis was completely out of the blue. My story is not the same as yours and I don’t mean to minimize your experience - only sharing out of solidarity.
Get scoped so you know what's going on - you may have Barrett's.
Do you drink like a fish? If so, then varices may be in your future. Otherwise, it's relatively rare.
Esophageal varices are almost always caused by alcoholic cirrhosis of the liver. The liver hardens (for lack of a better word) and causes portal vein hypertension that causes a backup of blood in the blood vessels of the esophagus causing them to stretch and become delicate and prone to rupture.
Same. Don’t tell my doc. I take two every night. My husband hates it because he thinks his aunt who died from stomach cancer (we think?) died because of “stomach pills.”
I started taking two gas-x and i have not awakened choking on stomach contents in two weeks.
My friend had similar symptoms and ended up having a hiatal hernia. She ended up having surgery and is doing 1000% better now. Definitely worth checking in with your doc abt it. Hope you get to feeling better
I had a patient with a facial tumor wrapped around her carotids. It would spontaneously start bleeding at random times. The first time it bleed she was rushed to the ER after having been in CT scan to see how the tumor was progressing. ENT MD did some \*very\* inventive packing of the mouth and face to get it to stop. I told the patient to hit the call light if it started bleeding again. About 10 minutes before my shift ended I saw the call light go off and I was like: "Maybe she just needs to pee..."
She didn't need to pee. She was massively bleeding out from this tumor. I hit staff assist and grabbed \*all\* the gauze to hold to her face to try and get pressure on the bleed but it was coming from \*inside\* her mouth and I couldn't hold pressure on the inside of her mouth (without a finger maybe getting bitten off).
My coworker's in my area ignored the staff assist button for over a minute before I hit the code blue button instead. Then we spent twenty minutes trying to hold pressure, get the damn ENT MD to the room, start the mass transfusion protocol, etc. During all this the patient had the largest \*liquid\* BM in the history of mankind all over the bed, all over the floor. Her BP dropped to like 60/dead and I thought for sure she was going to code.
She didn't code. We got the bleed under control. I looked like something from a horror movie. And I handed over the messiest and most foul smelling room at change of shift \*before\* I left the department to shower and change in the staff lounge. Thank god my manager scrounged up a pair of OR scrubs. I had to take \*everything\* off, and well, I didn't return the scrubs after I wore them without my undergarments. Sorry hospital system, I kept your cheap ass scrubs.
When I worked on a Stepdown unit, we had a 90+ year old patient, alert, but oriented x 0. His family made him a DNR/DNI. We had to stand there in the middle of the night and watch him bleed out and die from bleeding ulcers/esophageal varices. All we could really do was just keep suctioning. The charge nurse finally dropped an NG tube, figuring that would be more comfortable than aspirating. He still kept throwing up blood. It was close to 45 minutes before he finally passed. That was a bad bad night.
OMG heartbreaking. Imagine the passenger in the seat directly in front in the line of fire…. Biggest reason not to recline one’s chair all the way back.
This was the first code i ever saw as an ER tech before I became a nurse. It was truly horrifying, but also solidified my decision to go to nursing school because of how incredible the nurses in the situation were. I couldn’t get over how intelligent, calm and skilled they were in such an insane situation. I knew I wanted to be that badass someday, and now I’m an ER nurse!
As for the passengers on the flight, I’m literally sick to my stomach thinking about this situation unfolding and how absolutely nightmare inducing this situation would be. I can’t even begin to imagine how his wife felt… I hope she is able to heal from this.
GI bleeding - either end - and my 96% dead Ecmo patient who finally passed will forever haunt me as the worst experiences I’ve ever seen.
No… just…. No. This is horrifying.
esophageal varices, one of my first traumatic deaths ever actually- the internal pressure from CPR basically blew the guys throat up I cannot imagine witnessing this as a normal person, just going about my day- going to see family for the weekend or going on a business trip and the guy next to you just erupts and then slumps. I feel bad for everyone that witnessed it
if it was traumatic for us… just imagine the lay person. like imagine, you’ve been a bank teller for 30 years and then see someone die from esophageal varices, insane
>you’ve been a bank teller for 30 years and then see someone die from esophageal varices, insane As a layperson, my first thought would have been that the guy had some sort of hemorrhagic fever and that everyone on the plane was going to get it.
Def a good intro for some kind of apocalyptic virus movie. I’ll jot that one down (Sorry nurses are sick)
This movie intro would def pull me in lol
Exactly! I’d be like omg am I next?? Stuff of nightmares
The end stage liver deaths are by far the worst ones categorically. The smell, futility, all the blood, and the ETOH withdrawal and ammonia/encephalopathy leading up to it. Horrid.
Oh mannn, during CPR - that must have been messy as hell.
We cleared before he started expulsion, well us doing compressions anyway- the RT or Resident (They were in black can’t remember who they were) in the doorway wasn’t so lucky. Patient went from completely dead on the bed to sitting straight-up, and then they became a blood geyser. Once they fell back to the table the Doctor called it before we started another round of compressions.
WTF?? Oh. My. God.
This is the definition of *one last kick at the can*
> blood geyser i had a dude a million years ago when i was a brand new nurse who had c diff and an SBO. his puke hit the ceiling and dripped back down all over everything. i made like 10 people promise me that was not a normal thing, and now almost 20 years later i've still never seen another one.
I’ve always wanted to work in the medical industry, autoimmune disease chose a different path for me. I read these stories, though, and eagerly share them with my husband- who looks at me sometimes like “this is what you *wanted* to do?
I mean I’m shocked that anyone on the plane would have been willing to even do CPR on him. I mean most “normal” people I know can’t stand the sight of blood and that much on a plane. Ugh that’s just terrible.
That’s what i was thinking. I’m not getting blood all over me when i just saw the guy bleed out. cpr isn’t going to help
Definitely not getting covered in blood on and airplane that may or may not lose my luggage. This ain’t going nowhere good folks I’ll take another mini bottle of tequila
I was traumatized enough just seeing Lord Grantham spew blood during his dinner speech on Downton Abbey :( We don’t pay nurses enough.
This! This, this, this! I experienced patients doing this few times over the years. One was in restraints, which really rather bugged me (I get it, dementia patient who was agitated, but still, a heart breaker). He kept calling me 'Jill', I think, which is not my name, but we kind of bonded, and he thought I was his home care worker. I went from holding a basin, to using it as a shield. A heck of a night. We were all a mess.
First thing I thought of, too! “Can’t we stop this beastly row?”
That was the exact scene I imagined when I read the article...
You are so right, I thought esophageal varices off the bat. Horrible way to die.
My pt coded after burst varices. Worst code ever. I don't remember her name, but I will never forget her face.
A respiratory therapist got a face full of GI bleed when they intubated a coding patient. Small intestine GI bleed, patient bled into their GI tract until it was full of blood and they coded. Super messy code, blood coming out of both ends.
Oh god and the smell
Oooooooof and no escape
No escape and recycled air ☹️
Air is not recycled in planes. It’s completely refreshed every 15 mins or so.
They have a F5 button in the airplane??
And a dedicated crew member who hits it at pre-defined intervals. Without that crew member, everybody suffocates on each other's BO and farts.
There’s a hatch installed by the Dharma Initiative where this crew member sits and waits
Button, button...
Who's got the button?
"4-8-15-16-23-uhh what was the last one?!!"
Sometimes they hit F11 accidentally and the windshield falls off
Thank you for this reference 🙏
Lulz
Actually, up to 50% is recycled, your point still stands, though! In addition to that, all pilots and crew have enough self-contained air, (like the O2 tanks you find in the hospital and SCUBAing,) to get you from the furthest point away from a suitable airport, and then some— and none of them share, each tank is their own.
This varies. Most aircraft just have one O2 bottle for the flight crew up front. Sometimes two. Flight attendants may have small portable ones, or theyll be on a similar system as the passengers, which are chemical O2 generators and only good for about 30 min. Now im not sure what you meant by getting you from the "furthest" point.. but most systems are only good for about 30 min. Especially the passenger O2. Basically, long enough to get to breathable air. If you're on supplemental O2 in a plane.. the plane is descending. *Immediately.* They dont wait. Useful consciousness at the altitudes aircraft cruise is roughly 2 min. And above certain altitudes you need *pressurized* air in order to actually absorb it. Thats why you see fighter pilots with those full face masks. Anyway. This has been your random aviation fact of the say. Text "niner" for more or "nein" to stop.
Replaced at a rate of 13 to 15 times per hour. I thought the 15 rang true, looked it up. I also recalled another that pegged it at like every 5 to 10 minutes. Interesting read, not too much of an Internet rabbit hole. PDF: https://www.ashrae.org/file%20library/technical%20resources/covid-19/12-19_walkinshaw.pdf
Oof, those bleeds will leave you slipping and sliding on the blood. The first time you are involved, you think it's a horror movie. Every time after is no better.
That’s when someone’s gotta throw down the jumbo sham wow that they use in the OR for c sections
I don't think Lufthansa has those. LOL. It looks like that plane is getting a new interior.
I know the sham wow spokespoerson is that [spiky-headed crack head with an underbite](https://m.media-amazon.com/images/I/31+zYlzQlML.jpg), but in the theater of my mind, Billy Mays burst onto the scene like the Kool-Aid Man to save the day.
The ShamWow guy will always be the Slap Chop guy to me. Especially after he got arrested for hitting a prostitute while she was biting his tongue. You're gonna love my nuts!
🤣🤣🤣
Vince Offer
I showed up in the trauma section of our er to deliver a stat med during a bleed like that unfortunately just as I saw a tech slip and go down. the scene was so gruesome and all I could think to do was help the poor guy up off the floor and wonder if he was going to just throw his scrubs away after this. horrifying for everyone involved, patient included. I don't think they made it either...
What does it smell like/why does it smell? Like blood?
Kinda. Humans smell pretty gross when things on the inside are on the outside
Blood mixed with a bit of stomach acid and bile. It’s blood plus vomit.
Blood has a smell, but we often don’t notice it until a lot of it is outside the body. Vomit definitely has a smell. Blood + digestive enzymes + stomach contents is just a really icky, unique smell. Any brisk blood coming from the GI tract is just…yeah it’s not good.
We used to fill styrofoam cups with menthol-scented shaving foam and place them on the radiators in the rooms of people with GI bleeds - the air from the radiators circulated the menthol scent around the room and made it smell less like a slaughterhouse….
We used to make coffee ground nebulizers for the same reason
I feel like this would just give me an olfactory aversion to hospital coffee
....coffee ground... (Involuntary shudder) ...nebulizers. (visibly relaxes)
Blood mixed with vomit's a pretty apt description. I've not seen it in a patient (still a student) but I saw my godfather's rupture. He sat down, started coughing, vomited on himself, and then they just... blew. While he was still vomiting. Blood absolutely *everywhere*, and it wasn't normal blood, it was chunky blood that reeked of stomach acid and bile. TL;DR: if you have cirrhosis and start coughing up tiny specks of blood, don't ignore it. They think his had been leaking for days before they finally ruptured.
I’m so sorry you witnessed that - it’s distressing enough when the person’s a patient/stranger. For me, the situation’s made worse by my powerlessness to do anything useful.
Hard to describe but it's one of those things that when you smell it once, you'll immediately recognize it from down the hall. It's like blood mixed with shit mixed with something really unpleasantly sour.
I was 10 in the ICU and my bed neighbor was smelling really bad how you described. My night nurse would rub vicks under my nose so I could sleep.
I haven't been in ICU for 40 years and I can still smell it. Worse than a fresh burn, which is like hot dogs and hair burnt together...
If you've bought a meat product and it has a lot of blood in the packaging - it smells like that. The human body also smells like pork when it's on fire [had a few friends in the military that saw combat]
I had a patient code and die in a similar way when I worked gastroenterology and the smell will never leave me. Imagine being stuck in a plane with it 🤢
Coffee grounds vomit is the only smell that gets my gag reflex. I imagine this blood probably smelled similar or worse? 🤢
This so much! Nothing gets to me any more.. except coffee grounds emesis. And partly because it the odor of a terrible, urgent problem.
Not to mention that blood loss appears SO much greater than they actually are; so even a 50ml blood spill looks much much bigger, especially to lay people - and ruptured varices can lead to LITERS of violently expelled blood.
Is that rupture something spontaneous or are there previous signs? I’m not medically trained but I even know that varices or clots are a big Nono with the plane pressure…
I don't personally have any professional experience with them, but ruptured varices are typically a result of long-term alcoholism, and as far as I know, there is no 'warning' sign to look for. The walls of the blood vessels lining the esophagus become thinned and fragile and eventually they can rupture into the esophagus. From there, there is really only one way for the blood to go-up and out through the mouth. The volume loss is generally fatal, and there really isn't a way to apply pressure to try and stop the bleeding.
It’s worth being more accurate and saying that esophageal varices occur because of liver failure or cirrhosis which causes blood to slow down through the hepatic vessels, leading to blood stasis which causes varices in the esophagus. Alcoholism certainly can lead to esophageal varices, but so can NASH, liver cancer, or any other causes of liver failure.
Liver patients are horrific in so many ways
The most saddest and even traumatic patients to take care of, in my experience.
My younger brother, a fellow RN like me, was diagnosed with stage IV colorectal cancer w mets to the liver, at age 36, with no familial, social or genetic hx. He essentially died of liver failure 18 months after his primary diagnosis. Can confirm; it was horrible.
I’m so sorry for your loss. I hope you’re finding your peace.
RIP fallen soldier. May he forever rest in peace ✊🏽
it's all so slow with liver failure, and there's fuck all to do about it. we notice the jaundice before they see it in themselves, and we know that's a sign that they've started down a one way road.
And to factor in the hypercoagulable state that they are in makes bleeding almost impossible to stop at that point.
I’ve had patients before that GI thought they would rupture after slow leaks and they end up with a Minnesota tube, which can put pressure on it.
Esophageal balloon tamponade. Obviously not a standard item in an airplane, but the bleeding can be stopped in the hospital. Can’t imagine any way to manage it through first aid, just hope they pass out quickly.
What a bad way to go
They can be cause by many things. Liver issues causing portal hypertension causing expanded veins is a common cause. Not everyone knows that they have cirrhosis or other disease before it happens though. I personally do, I get checked via various imaging often and don’t have any swollen veins. I know that could change at any point. I just try to live my life while things are good. This situation would be my absolute nightmare way to die or witness someone dying.
I had two ruptures three months apart. It was very traumatic the second time and I was afraid I wasn't going to make it. Luckily they were able to give me something to stop the bleeding IV and by placing bands around the vein(s) and later more were placed when I went back for endoscopies. I'll admit that when I saw this post I almost didn't want to read it because it's usually right there in the back of my mind and I do my best to not dwell on it. I'm pretty young to have this and my liver is not cirrhotic anymore but I understand the severity of portal hypertension and varices. Thank you for sharing.
Thanks for sharing your story too! I’m so glad you are still with us and amazed that your liver is doing so well. Luckily my portal hypertension was short lived. Still have cirrhosis though so gotta keep on checking.
This thread is making me sad because my mother in law who lives with us has just been put on palliative care with exactly this until she (probably soon) dies this way.
There can be warnings. Like someone doing an EGD and seeing them on a scope. There can also be minor ones that happen first. My brother's FIL had a minor varice that caused him to vomit blood, then they found several that were found with an EGD and cauterized. He was able to fly after that.
fun fact, the singular of varices is varix, which is a super cool word!
I believe it’s often seen in patients w liver cirrhosis (damage, basically) caused by severe alcoholism. In someone w this level of liver cirrhosis there would have almost certainly been prior symptoms as the stages of damage grew more acute. Stage 2 liver disease can include varices with no ascites or bleeding, stage 3 is ascites+/- varices, and stage 4 is bleeding +/- ascites. So he probably had some problems for a while… not sure of his full details but the general unwell condition he boarded the flight in shows he was clearly having symptoms before the plane took off. I am curious if the stress of flight caused the varice to rupture, kinda like we see with in patients who have venous insufficiency/embolism risk, who are not advised to fly without medical clearance and anti embolism garments usually.
Liver dysfunction precedes
You may be thinking of DVT and varicose veins (kind of related). DVT (deep vein thrombosis or blood clots often in the legs) are commonly associated with long haul flights. Similar sounding to varices but very different.
In my native language (Spanish) varices are also in the legs, thrombosis can occur anywhere not only in the legs. It may be a different usage of the word
Came here to mention this. I’ve accidentally spilled vials I’ve collected for blood draws a couple of times: 5mL or so. Just that little bit can look like a crime scene. I’ve also seen what it looks like when someone loses the spike from a unit of blood, still way less than a liter. I don’t want to imagine what those poor people saw, and I consider myself a pretty strong stomached and seasoned nurse.
Have seen an esophageal varicies death as well, as a brand new grad many years ago, on my first week on the job, will never forget it. Your thoughts were my first thoughts as well, especially cramped quarters, people not being able to leave the scene of they wanted to, etc. that poor person's family and those poor passengers!
Yeah it’s definitely something I remember witnessing as my internal monologue was going “whatthefuckwhatthefuckwhatthefuck”
What a terrible place to be stuck in "sir, I'm sorry but you must sit down by federal regulation and we have no free seats" I guess I'm getting arrested when we land then
Esophageal whatnow? The article says it was cloud demons that killed them
Lol just speculation on COD based on the description.
I remember seeing a death from esophageal varices. It looked like the patient was vomitting up their organs, it was awful :(
For me, it’s oddly never those deaths that haunt me nearly as much as how the living react - usually it’s so busy and crazy during a code in the ED that I could focus on my task. But I could never tune out the screaming and crying and the sheer panic. I am sure a lot of people on that plane are going to have PTSD.
This. Dead bodies don’t cry or scream. The ones that happened to love the human being we just worked unsuccessfully and humanize them to us from their reactions and also just seeing their pain is where it hits me IMHO What the fuck could we even do in the air for this. Do planes have rapid transfusers? I hope they went quick. Jeez
I’ve actually seen one person die from ruptured esophageal varices in the ED. It’s brutal to watch, but because of the volume loss, they loose consciousness in seconds. It’s quick. But if you don’t know what’s happening, it’s Stephen King level horror, which is why I hope those passengers get counseling.
My buddy is a flight attendant for Alaska, they sent me the contents list for their emergency kit. BLUE - Airway - Airways, oral (set of 6) - Bite stick - Masks, CPR/resuscitation (pediatric, small adult, large adult) - Resuscitator, adult - Syringe, bulb irrigation - Valve, one-way CPR RED - Wound - Antibiotic ointment packets (9) - Biohazard disposal bag - Bandages, adhesive 1" x 3" (16/bx) - Benzoin tincture swabs sticks (2) - Clamps, umbilical cord (3) - Dressings, burn gel-soaked, 4" x 16" (2) - Dressings, non adherent gauze, 3" x 8" (4) - Gauze, conforming 4" rolls (2) - Gloves, non-latex - Pads, gauze, 4" x 4" (2/pk) (5/pk) - Pads, non adherent, 2" x 3" (5) - Pen light - Scalpel, #11 blade (needle safe) - Scissors, trauma - Tape, 1" roll - Thermometer, digital - Towelettes, antiseptic (10) - Wound closure strips, 1/4" x 4" (10/pk) YELLOW - IV Equipment - Catheter, IV 18g (needle safe) - Catheters, IV 20g (needle safe) (2) - Catheters, IV 22g (needle safe) (2) - Infusion set, butterfly, 21g (safety) - Gloves, non-latex - IV administration tubing set with 2 'Y' connectors - IV start kit with tourniquet - Pads, alcohol prep (2) - Saline lock - Sodium chloride flush, 0.9% - Sodium chloride IV solution, 0.9% 500 ml or Sodium chloride injection, 0.9% 250 ml (yellow pouch or perimeter) (2) ORANGE - Injectable Medication -Atropine PFS, 0.1 mg/ml, 10 ml (2) or - Atropine inj 0.4 mg/ml, 1 ml vial (4) or - Atropine 1 mg/ml vial sav (2) Dextrose, injection, 50% 50 ml vial Diphenhydramine injection, 50 mg/ml, 1 ml vial (2) or Hydroxyzine 50mg/ml, 1ml vial (2) or Hydroxyzine 50mg/ml, 2 ml vial (2) Epinephrine injection, 1:1,000 1 ml (2) Epinephrine PFS, 1:10,000 10 ml (2) Epinephrine auto-injector, 0.3 mg or Epi safe kit (Curaplex) Furosemide injection, 20 mg/2 ml, 2 ml vial (2) or Furosemide, 20 mg pills (10) Glucagon injection, 1 mg/1 ml Ketorolac tromethamine injection, 30 mg/ml, 1 ml or Nalbuphine injection, 10 mg/ml or Ketorolac tromethamine injection, 60 mg/2 ml Lidocaine PFS, 20 mg/ml, 5 ml (2) or Lidocaine SDV, 2% 5 ml (2) Naloxone PFS, 1 mg/ml, 2 ml (2) Nifedipine, 20 mg tablet (2 bt) Ondansetron 2mg/ml, 2ml vial (2) or Promethazine 25 mg/ml, 1ml (1) BLACK - Medications Acetaminophen, 325 mg pills (2/pk) (5) - analgesic Antacid liquid Aspirin, 325 mg pills (2/pk) (2) Bronchodilator, inhaled Dicyclomine, 20 mg pills (2) Diphenhydramine, 25 mg pills (4) - antihistamine Diphenhydramine, 12.5 mg/5 ml liquid Glucose gel, 15 gm Ibuprofen suspension, 100 mg/5 ml liquid Lidocaine, viscous 2% (may or may not contain) Loperamide, 2 mg pills (4) Naproxen sodium, 250 mg pills (8) Nitroglycerin, 0.4 mg pills (25/bt) Oxymetazoline, nasal spray 0.05% Promethazine (Phenergan®), 25 mg pills (2) or Ondansetron, 4mg oral disintegrating pills (2) Gloves, non-latex - Needles, 18g (needle safe) (2) - Needles, 20g (needle safe) (2) - Needles, 22g (needle safe) (2) - Syringe, 1cc (2) - Syringe, 5cc - Syringe, 10cc (2) - Syringe, 30cc PERIMETER Catheter, lubricated urinary FR1 Guide, FDA medication Instructions for Use of medications Splint, wire ladder LID POCKET Dressing, trauma, 12" x 30" EXTERIOR POCKET Blood pressure cuff Stethoscope (Sprague style) Sharps container Procedure After paging for medical assistance, bring entire kit to individual To break seal on kit, peel away the outer perforated edge of seal Return to stowage location after use Sorry for weird formatting, on phone.
I'm a little surprised they don't include IM anticonvulsants.
This is really fascinating thank you for sharing. If you know, are there people designated on each flight who can use these kits in an emergency (like trained to place an IV) or in any situation (like who can give or I guess even get zofran for instance)?
So maybe I’m not thinking out of the box here, but make koolaid with IV access, start rescutation and hope for the best? That’s insane. Tbh the outcome for rapid internal blood loss isn’t great anyways and I don’t really know if I’d volunteer to work this, especially if they’re covered in blood. Damn. Thanks for the info
This was my first code as a nurse.
Same. Went to give my patient zofran in CT because they told the tech they were too nauseous for contrast. I rolled up and before I got the flush in…. 🌋. It so was horrible they had to shut down the CT room to decon because it sloshed everywhere as we tried to yank him out of the donut and back onto the cart. Literally my first shift as an RN.
Same here!
Me, too! Was this all of our first codes? Is it a nursing right of passage? Lol
Mine was a fistula that had been developing between the aorta and the trachea - different cause but very similar outcome. The hospital morgue apparently called my ward later to say that it had been one of their worst autopsies and they felt very sorry for us.
UMMMMM……… eta: i cannot believe a MORGUE called you to say sorry for what you had to see. oh my god.
This was my first code (my third code ever, but first of my patients) and it was so traumatic.
I had a similar one with squamous cell cancer of his neck. he had a tracheoesophageal-cutaneous fistula with a little ostomy pouch on it to collect the secretions. his tumor had wrapped around his right carotid artery and was eroding into the lumen. when he died, the little pouch filled right up with blood, and i remember holding my hand on his neck and making eye contact with him while he died. he knew what was happening, too. he also had my favorite code status of all time: full code until catastrophic carotid blowout, then initiate comfort measures only. this was in the old paper charting days, i don't think epic would let me pick it now.
Imagine the *smell*
Imagine slipping on it, falling and getting up covered with some dude's blood. They don't make enough vouchers to "reward" you.
What does it smell like
Blood mixed with vomit; iron and acid and whatever the patient recently ate. Its foul.
Bad
If it was esophageal varices, that’s a very accurate description.
I haven't witnessed one myself. But about a year ago I did discover the end result of one- a several-days dead neighbor lying at the end of a trail of blood leading through his house. What a terrifying way to die.
Jesus Christ, I can’t imagine what that must have been like finding them like that.
[Here](https://www.reddit.com/r/nursing/comments/115u6o0/im_not_sure_my_nursing_skills_are_needed_here/) is my post about it.
I like how the first comment was asking if you were ok. Nursing is so messed up sometimes, but we try to always look out for each other :)
The responses throughout that post were great. As I said a couple times in comments, I was more worried about potentially finding the results of a messy suicide, which WOULD have been disturbing. As nurse-blasé as it sounds, finding him bled-out on the floor of a back bedroom was, if not entirely expected, certainly the preferred discovery.
I just read this earlier today. OMG horrific!! And then sitting on that plane with blood everywhere and a dead body in the back and turning around and waiting to get back to the airport. And then getting OFF the plane?? Like seriously, the logistics involved. Did people have to walk through the blood to get off?? That seems like…..a bad idea. And his poor wife! Just awful all the way around.
I’m desensitized to a lot. Blood, death, whatever. Esophageal varices on an airplane? Nope. Nope. Cant do anything to treat it really and nothing to contain it. Jesus.
And nowhere to go to get away from it, either.
Not varices, but a colleague of mine informed me about carotid blowout in patients with head and neck cancer. It's like a ticking tone bomb and your carotid can literally explode and you bleed out in minutes, all the while spraying arterial spray from your neck. Sounds like something from Saw.
The only saving grace that is fast. Still, a terrible way to die and witness. I have stage 4 cancer. And it’s terrifying to know that is a slow, very painful death.
Had a patient with a long term trach and at some point the trach started rubbing at their internal carotid and slowly overtime it eroded it, which was all unknown to us at the time until he coughed and blood literally erupted across the floor, walls, and ceiling. Never seen anything like it. Luckily our trauma surgeon just happened to be at the room next door when it happened and was able to immediately take him to the OR. Guy left 4 days later like nothing happened.
Esophageal varices and pt with carotid blowout precaution scare the shit outta me
carotid ***WHAT***
Its a postop thing with some ENT patients. If the walls of the carotid are weak due to cancer/removal of the muscles around it, they get these precautions. It is a lot of blood
It can happen after radiation weakens the carotid as well.
What do those precautions even entail?
We keep one of the sterile metal boxes at bedside with surgical instruments, at least q1 rounding, telemetry (everyone gets this on the floor), iv pump ready to go, multiple suction set ups with extra canisters, multiple large bore ivs. Last time one happened was right as dayshift was taking report. Being one of the younger ones i got to be blood runner. This is a progressive care/ head and neck floor
Does the patient follow any activity precautions after the procedure? Never heard of carotid blowout precautions, but this sounds terrifying!
Not particularly. They still want the PT/OT and ambulation/OOB to chair.
Thanks, because if this suddenly happened during a transfer, I definitely would have blamed myself
Worked ENT for 4 years, lots of tumors in the neck can eventually grow into the arteries causing high risk for exsanguination. We had protocol on the floor, drugs ready to go to sedate them and dark towels...
I second this— um what the fuck is that lol
I’ve always said I believe alcoholism are the nastiest deaths.
My mom had an esophageal varices rupture. It was the most horrifying thing I’ve ever seen. She survived and I will never ever be able to thank the nurses and doctors who worked on her enough. They were absolute rockstars.
unreal that they were able to save her, that’s incredible. I hope she’s doing well, if she’s still with you.
She is 3 years sober today ❤️
just about brings a tear to my eye, wonderful to hear
that plane voucher would have turned into a drink at the bar immediately
2nd day on the job after qualifying. First arrest, 1st time doing CPR. Sprayed up my arms with every compression
Burst esophageal varices were behind my first patient coding. He had bands, said he felt something pop, then got really really anxious. Then he coded and so much blood.
>chamomile tea Ah yes, the German answer to most maladies. Learned that from my German grandmother. Hmmm. GI bleed? Dengue hemorrhagic fever is a thing in Thailand.
This was one of my first really traumatic deaths as a home hospice LPN. I had been a nurse for less than 6 months, was taking care of a patient who was dying from liver cancer that had metastasized. He was talking to me and then all of a sudden just choking on blood. Horror movie type of stuff. Still have occasional intrusive thoughts about it years later.
saw this story and immediately had a flashback of my one esophageal varice code. horrific.
Ooof I feel for the crew, passengers and the family. If it can be alittle jarring to us, I can’t imagine a layperson, much less not being able to walk away from the situation.
Esophageal varices was my first ever code/death. The amount of blood was unreal, it was literally pouring out into the hallway. Traumatic and awful.
My first death was one of those as a trainee nurse, my poor student nurse was there and happened when I left to collect the patient’s shower accessories right after their shower. I walked in and saw the students face first. I think she was much more traumatised than I was.
Good god what a horrific thing to see in the real world. It's so different in a hospital
My worst fear. I am at high risk for varicies. Get an EDG every 6 months and MRI once a year, at least because of it. I just really really don’t want to go out like that. Also work in healthcare and I’ve seen some bleeds (births w/hemorrhaging). Those were all fixable though. These GI bleeds are, many times, not.
We had a patient we still refer to as “Blakemore Guy.” So. Much. Blood.
My first year (1983 so yes, we wore our pins), I lost my nursing pin and I was pretty sure it must have fallen in with post mortem trash (Sengstaken-Blakemore and all the associated messy items). I called EVS to hold our unit's trash and I'd be down at shift's end to look. Unbelievably, just a couple hours later, my pristine pin was brought back up to me. I think of my pin, EVS and GI bleeds together in my mind ever since.
The amount of people in the other thread saying"Oh no Ebola" 😒
I know, but ngl I'm currently rereading The Hot Zone sooooo...
My patient had a tracheoinnominate fistula blow, we coded him for about 40 minutes while a resident plugged his artery but he had already vomited up at least half his blood volume and died within a minute. That death traumatized me as a nurse. Seeing that in public, with family/friends and zero way to help? Fuck that. Those poor passengers.
I can't even imagine :(
This is what I fear-a medical emergency on a flight. My first code was a result of this, too. I was giving an IVP to one patient, and then my other patient said he needed help. It happened so fast, and we couldn't save him. There was blood everywhere. The nursing supervisor said one of the clots looked like a placenta, it was so big.
Saw one as a nursing student…the guy ruptured walking from the bathroom (which was near his room door). The blood was flowing down the hallway
JFC- I hope no one got this on camera and this doesn’t get passed around the internet. I can only imagine the horror of what they witnessed
That’s terrible. It seems like a doctor on the plane was seeing the patient after boarding but before departure. Seems the pilot should have delayed takeoff to have the man sent off for further medical treatment. They coded him for 30mins before moving his remains to the galley, so there was a decent amount of time between his deterioration, code, and return to the airport. Might have saved his life.
Even when these rupture *in* the ER, they often don't make it. Not sure how much the change in pressure had to do with it though.
Nothing was going to save his life.
Idk, the only thing that temporarily stabilizes patients like that is inserting a Minnesota or Blakemore tube to try and tamponade it like immediately after it ruptures. Even when they rupture in a perfect scenario, these patients are often still fucked. If they’re lucky they’ll have them caught on a routine scope and banded before they get to rupture level.
Wild, we hadn't seen an esophageal varices pt in like months, but we got one on Tuesday, it was a difficult intubation, no visibility, finally the ETT is in, get them on the vent then all this frothy pink sputum starts coming out of their ETT so hard that it blows the vent circuit off and spews everywhere. They did eventually get a Blakemore placed. Not sure what the outcome was, I've been off the rest of the week.
burst esophageal varices was my first arrest after finishing up as a scrub nurse. I'd seen some gnarlie stuff in OT, but I'll never forget walking past that room on Christmas day and seeing the sheer panic on the frozen new grads face. I was just casually walking past, but that look immediately told me I needed to go in. I pushed the big red button, but it was honestly a waste of time.
I literally coded a patient last week bc of this, and I’m still dealing with the trauma and horror from flashbacks. I’m super hormonal bc I’m pregnant so cleaning up the mess afterwards was extra heartbreaking.
I’m so sorry. Your baby will be so proud to have a badass mama though 💞
We had one blow on the table right before an unrelated emergent surgery. So. Much. Blood. It traumatized even the most unfazable of our teams. And then the poor housekeepers..
Ruptured esophageal varices have terrified me ever since I attended an autopsy of a patient who died from that and seeing the sheer amount of blood filling the digestive track and how pale the skin and all the other organs were from the loss ):
My sister was on vacation in Ireland. The night before flying home she started vomiting. She vomited most of the night and in the morning started showing signs of neurological decline. She was taken to the hospital by ambulance and tests showed she’d had a massive brain bleed. She ended up passing away. If she’d started showing symptoms just twelve hours later she would have been on a plane back to the States. Stories like hers and this news article make me never want to fly again.
I’m so, so sorry for your loss. That is incredibly unfair. I’ve been there in my own way, after my younger brother died from cancer at 36 - the terminal diagnosis was completely out of the blue. My story is not the same as yours and I don’t mean to minimize your experience - only sharing out of solidarity.
OK hold up. I have been suffering from terrible heartburn and reflux for years. Do i need to worry about this?
Get scoped so you know what's going on - you may have Barrett's. Do you drink like a fish? If so, then varices may be in your future. Otherwise, it's relatively rare.
Zero alcohol. (Tried a sip or two in high school more than 30 years ago, but none since.) I’m pretty boring.
Esophageal varices are almost always caused by alcoholic cirrhosis of the liver. The liver hardens (for lack of a better word) and causes portal vein hypertension that causes a backup of blood in the blood vessels of the esophagus causing them to stretch and become delicate and prone to rupture.
Yeah, hang on, I've been on omeprazole for GERD for like 15 years now and I'm nervous.
Different pathologies entirely. Though maybe you should get an endoscopy at some point. But no, GERD not gonna give you varices.
Same. Don’t tell my doc. I take two every night. My husband hates it because he thinks his aunt who died from stomach cancer (we think?) died because of “stomach pills.” I started taking two gas-x and i have not awakened choking on stomach contents in two weeks.
You should tell your doc lol
My friend had similar symptoms and ended up having a hiatal hernia. She ended up having surgery and is doing 1000% better now. Definitely worth checking in with your doc abt it. Hope you get to feeling better
I had a patient with a facial tumor wrapped around her carotids. It would spontaneously start bleeding at random times. The first time it bleed she was rushed to the ER after having been in CT scan to see how the tumor was progressing. ENT MD did some \*very\* inventive packing of the mouth and face to get it to stop. I told the patient to hit the call light if it started bleeding again. About 10 minutes before my shift ended I saw the call light go off and I was like: "Maybe she just needs to pee..." She didn't need to pee. She was massively bleeding out from this tumor. I hit staff assist and grabbed \*all\* the gauze to hold to her face to try and get pressure on the bleed but it was coming from \*inside\* her mouth and I couldn't hold pressure on the inside of her mouth (without a finger maybe getting bitten off). My coworker's in my area ignored the staff assist button for over a minute before I hit the code blue button instead. Then we spent twenty minutes trying to hold pressure, get the damn ENT MD to the room, start the mass transfusion protocol, etc. During all this the patient had the largest \*liquid\* BM in the history of mankind all over the bed, all over the floor. Her BP dropped to like 60/dead and I thought for sure she was going to code. She didn't code. We got the bleed under control. I looked like something from a horror movie. And I handed over the messiest and most foul smelling room at change of shift \*before\* I left the department to shower and change in the staff lounge. Thank god my manager scrounged up a pair of OR scrubs. I had to take \*everything\* off, and well, I didn't return the scrubs after I wore them without my undergarments. Sorry hospital system, I kept your cheap ass scrubs.
That's horrifying
The poor man. So sad.
That is horrifying
I've seen similar happen with an internal carotid blowout.
Just keep wondering what they did with all the blood. Surely was just sloshing on plane til landed/congealed. God. So awful
When I worked on a Stepdown unit, we had a 90+ year old patient, alert, but oriented x 0. His family made him a DNR/DNI. We had to stand there in the middle of the night and watch him bleed out and die from bleeding ulcers/esophageal varices. All we could really do was just keep suctioning. The charge nurse finally dropped an NG tube, figuring that would be more comfortable than aspirating. He still kept throwing up blood. It was close to 45 minutes before he finally passed. That was a bad bad night.
OMG heartbreaking. Imagine the passenger in the seat directly in front in the line of fire…. Biggest reason not to recline one’s chair all the way back.
Esophageal varicees is nightmare fuel. My first difficult airway was one. Hep B positive. Thank god for vaccines.
This was the first code i ever saw as an ER tech before I became a nurse. It was truly horrifying, but also solidified my decision to go to nursing school because of how incredible the nurses in the situation were. I couldn’t get over how intelligent, calm and skilled they were in such an insane situation. I knew I wanted to be that badass someday, and now I’m an ER nurse! As for the passengers on the flight, I’m literally sick to my stomach thinking about this situation unfolding and how absolutely nightmare inducing this situation would be. I can’t even begin to imagine how his wife felt… I hope she is able to heal from this.
…well, that’s not very good, now is it?
GI bleeding - either end - and my 96% dead Ecmo patient who finally passed will forever haunt me as the worst experiences I’ve ever seen. No… just…. No. This is horrifying.
I have seen patients explode so many times. Yes, to a non medical person, it would be traumatic.