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.”
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.
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.
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.
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.
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.
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.
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 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!
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.
CPR is like blowing into a cartridge game expecting it to work again. It hardly ever works and if it does, it’s not going to work next time unless there are some major changes.
That is so utterly wrong. It all depends on the cause of death.
Especially sudden traumatic deaths, such as choking or drowning, where the rest of the body was little impaired, have crazy high recovery chances if immediate and persistent CPR is applied.
And even on chronically I’ll patients, e.g. the commonly thought of cholesterol caused infarction and subsequent heart attack has a good chance to recover. Modern medicine is amazing!
But in most cases, you simply won’t know in the moment why somebody dies. And does it matter? You can make assumptions, but you could be totally wrong. So leave that part to the EMTs and doctors. Your job as a human in that moment is to give someone the best chance they will get to experience more life.
In all cases the chances of survival and recovery sink with literally every second, which is why it can be so frustrating to see people too scared or cynical to even try. What are you afraid of? You can’t make em any more dead. And I truly hope anyone would be willing to “waste” the time and effort to at least try if I suddenly died. Even if your CPR is too weak, too strong ( yes, also possible, albeit very rare), too slow or too fast: the by far worst CPR is the one not given at all.
And I can promise you this: you will never regret having attempted to do CPR, even if there is no resuscitation.
I am sorry if I offended you. I wasn’t being dismissive of CPR. I actually am certified by the Red Cross for CPR and my mother and sister are nurses. I was under the impression it was a last ditch effort that hardly ever works. And if it does it’s usually broken ribs and hard to recover from when they are extremely elderly.
On its own, it has a very low percent chance of recovery. Though it does change based on the mechanism of injury. However, it is extremely useful in prolonging the period in which other medical interventions can be successful. It very much gives time for EMTs to arrive and use defibrillators or chemical intervention.
I’m confident in your training they made it extremely clearly to call 911 and start emergency responders before starting CPR if you are the only person there.
CPR alone usually wont bring someone back, but what it does is buy time for them to get more advanced treatment that might.
There’s some exceptions, things like asphyxia and drowning have a pretty decent chance of bringing the person back if it’s done properly and promptly. In things like opioid overdoses it can buy you a couple critical minutes for cops or the ambulance to get there and shoot some narcan up their nose and then they’re back on their feet in no time flat.
Fun fact: you can get narcan to carry as a first aid measure from almost any pharmacy, and many local health departments host narcan trainings and give it out for free. Giving someone narcan when they don’t need it won’t do anything at all, so the worst you’re doing is nothing, and the best case scenario, you can save a life.
I actually performed CPR during an industrial accident. A contractor was welding at a large power plant, and someone sabotaged the acetylene bottles by opening the valves on 3 cylinders, then torquing the cap on with a pipe wrench. 3 people collapsed from asphyxiation and their entry attendant sounded an alarm, they were pulled out by a few people with SCBA’s we kept close by due to confined space entry rules. That right there was the life saver, we drug them out, administered CPR, broke the fuck out of their ribs and they started breathing again.
It was a very lucky scenario for the survivors as they collapsed and received CPR in about 120 seconds.
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.
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.
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.
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.
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.
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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.
What?
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
Remind her you will have a lifetime burden of guilt if you don’t attempt to resuscitate her
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.
And if you aren’t humming Mad World as you do both, how can you even expect to travel through a worm hole?
Familiar faces, wormhole prophets. Morn out faces.
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 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!
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.
CPR is like blowing into a cartridge game expecting it to work again. It hardly ever works and if it does, it’s not going to work next time unless there are some major changes.
That is so utterly wrong. It all depends on the cause of death. Especially sudden traumatic deaths, such as choking or drowning, where the rest of the body was little impaired, have crazy high recovery chances if immediate and persistent CPR is applied.
And even on chronically I’ll patients, e.g. the commonly thought of cholesterol caused infarction and subsequent heart attack has a good chance to recover. Modern medicine is amazing!
But in most cases, you simply won’t know in the moment why somebody dies. And does it matter? You can make assumptions, but you could be totally wrong. So leave that part to the EMTs and doctors. Your job as a human in that moment is to give someone the best chance they will get to experience more life.
In all cases the chances of survival and recovery sink with literally every second, which is why it can be so frustrating to see people too scared or cynical to even try. What are you afraid of? You can’t make em any more dead. And I truly hope anyone would be willing to “waste” the time and effort to at least try if I suddenly died. Even if your CPR is too weak, too strong ( yes, also possible, albeit very rare), too slow or too fast: the by far worst CPR is the one not given at all.
And I can promise you this: you will never regret having attempted to do CPR, even if there is no resuscitation.
I am sorry if I offended you. I wasn’t being dismissive of CPR. I actually am certified by the Red Cross for CPR and my mother and sister are nurses. I was under the impression it was a last ditch effort that hardly ever works. And if it does it’s usually broken ribs and hard to recover from when they are extremely elderly.
On its own, it has a very low percent chance of recovery. Though it does change based on the mechanism of injury. However, it is extremely useful in prolonging the period in which other medical interventions can be successful. It very much gives time for EMTs to arrive and use defibrillators or chemical intervention.
I’m confident in your training they made it extremely clearly to call 911 and start emergency responders before starting CPR if you are the only person there.
CPR alone usually wont bring someone back, but what it does is buy time for them to get more advanced treatment that might.
There’s some exceptions, things like asphyxia and drowning have a pretty decent chance of bringing the person back if it’s done properly and promptly. In things like opioid overdoses it can buy you a couple critical minutes for cops or the ambulance to get there and shoot some narcan up their nose and then they’re back on their feet in no time flat.
Fun fact: you can get narcan to carry as a first aid measure from almost any pharmacy, and many local health departments host narcan trainings and give it out for free. Giving someone narcan when they don’t need it won’t do anything at all, so the worst you’re doing is nothing, and the best case scenario, you can save a life.
I actually performed CPR during an industrial accident. A contractor was welding at a large power plant, and someone sabotaged the acetylene bottles by opening the valves on 3 cylinders, then torquing the cap on with a pipe wrench. 3 people collapsed from asphyxiation and their entry attendant sounded an alarm, they were pulled out by a few people with SCBA’s we kept close by due to confined space entry rules. That right there was the life saver, we drug them out, administered CPR, broke the fuck out of their ribs and they started breathing again.
It was a very lucky scenario for the survivors as they collapsed and received CPR in about 120 seconds.
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.
CDC’s take on excessive alcohol
Binge drinking, the most common form of excessive drinking, is defined as consuming
Heavy drinking is defined as consuming
Hospital usually see people on their worse. Friends and family see them on the way to their worse stage.
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.
My wife’s aunt died from Cirrhosis of the liver and “so much blood” is exactly what my wife said she saw.
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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.
Unsure, but it probably didn’t help.
Just another reason I’m glad I don’t care to drink alcohol… did not know this was even a thing 🤢
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…