this post was submitted on 11 Feb 2024
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  • A 63-year-old man died on a Lufthansa flight on Thursday, according to Swiss-German outlet Blick.
  • Witnesses told the outlet the man had blood gushing from his nose and mouth.
  • The witnesses said passengers were screaming at the sight.
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[–] [email protected] 365 points 9 months ago* (last edited 9 months ago) (7 children)

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

[–] [email protected] 109 points 9 months ago (1 children)

I’ll take “Reasons to never drink again for $200, Alex.”

[–] [email protected] 102 points 9 months ago* (last edited 9 months ago) (3 children)

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.

[–] [email protected] 30 points 9 months ago (4 children)

I scream, “break the ribs!” every time I see movie CPR haha

[–] [email protected] 48 points 9 months ago (2 children)

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!"

[–] FauxPseudo 39 points 9 months ago (2 children)

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.

[–] TokenBoomer 16 points 9 months ago (2 children)

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!

[–] FauxPseudo 12 points 9 months ago

I am from the internet. I'm here to help.

[–] [email protected] 7 points 9 months ago* (last edited 9 months ago)

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 @[email protected]

[–] CosmicCleric 5 points 9 months ago (2 children)

Basically there has to be a 90% chance of an almost instant full recovery before I’m allowed to help her at all

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.

[–] TokenBoomer 10 points 9 months ago (1 children)

I believe they’re thinking of a full commitment that you wouldn’t get from any other guy.

[–] CosmicCleric 1 points 9 months ago (2 children)

I believe they’re thinking of a full commitment that you wouldn’t get from any other guy.

What?

[–] TokenBoomer 7 points 9 months ago (1 children)
[–] CosmicCleric 11 points 9 months ago* (last edited 9 months ago)

FauxPseudo rickrolled us.

Lol! Oh fuck! Well, somedays you get the bear, and other days the bear gets you.

[–] TriPolarBearz 2 points 9 months ago* (last edited 9 months ago) (1 children)

Many people are no strangers to this type of agreement. But for those who are not familiar, I believe this video has gotta make you understand.

[–] [email protected] 1 points 9 months ago

Here is an alternative Piped link(s):

this video

Piped is a privacy-respecting open-source alternative frontend to YouTube.

I'm open-source; check me out at GitHub.

[–] FauxPseudo 3 points 9 months ago (2 children)

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.

[–] peopleproblems 4 points 9 months ago

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

[–] Pretzilla 1 points 9 months ago (1 children)

Remind her you will have a lifetime burden of guilt if you don't attempt to resuscitate her

[–] FauxPseudo 2 points 9 months ago

I'd have a lifetime of guilt if she was there staring into empty space. There is no easy answer.

[–] [email protected] 4 points 9 months ago (1 children)

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.

[–] [email protected] 2 points 9 months ago (1 children)

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.

[–] [email protected] 2 points 9 months ago

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.

[–] Viking_Hippie 11 points 9 months ago (1 children)

And yet everyone looks at me funny when I see the same and yell "sweep the leg!"

[–] FauxPseudo 4 points 9 months ago (1 children)

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.

[–] Viking_Hippie 1 points 9 months ago (2 children)

And if you aren't humming Mad World as you do both, how can you even expect to travel through a worm hole?

[–] FauxPseudo 2 points 9 months ago

Familiar faces, wormhole prophets. Morn out faces.

[–] AA5B 9 points 9 months ago

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?

[–] [email protected] 1 points 9 months ago

I took an infant CPR class at the NICU after my son was born with a slight pneumothorax (air pocket outside his lungs).

They have is these tiny CPR dummies to practice and basically told us to put them on floor and try to press your fingers right through them to the floor. It was so hard to imagine doing it toa real child, and thankfully—6 years in—I haven’t had to.

Much respect to you guys who do it for a living to help the rest of us when we need it most!

[–] Fondots 15 points 9 months ago (1 children)

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.

[–] Xanis -1 points 9 months ago (2 children)

May I ask what you consider to be alcohol abuse? Yes, there are papers and sites and all that. I tend towards trusting the opinion of people on the ground a bit more.

[–] [email protected] 10 points 9 months ago

CDC's take on excessive alcohol

Binge drinking, the most common form of excessive drinking, is defined as consuming

For women, 4 or more drinks during a single occasion. For men, 5 or more drinks during a single occasion.

Heavy drinking is defined as consuming

For women, 8 or more drinks per week. For men, 15 or more drinks per week.

Hospital usually see people on their worse. Friends and family see them on the way to their worse stage.

[–] somethingp 5 points 9 months ago

I'm not sure what you consider to be people on the ground, but one would argue the people publishing peer reviewed research in the field have dedicated a significant part of their lives to that topic and are as "on the ground" as possible when it comes to their area of expertise.

[–] baronvonj 43 points 9 months ago

My wife's aunt died from Cirrhosis of the liver and "so much blood" is exactly what my wife said she saw.

[–] [email protected] 11 points 9 months ago* (last edited 9 months ago)

Just another reason I’m glad I don’t care to drink alcohol… did not know this was even a thing 🤢

[–] peopleproblems 7 points 9 months ago

Well that is pretty horrific

[–] [email protected] 6 points 9 months ago

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.

[–] Sekrayray 4 points 9 months ago

You know it’s a been a bad day when you arrive to your shift and the Blakemore box is out…