I’ve seen some esophageal varices as a medic and let me tell you those guys are bleeders. Feel bad for people not knowing the situation, it honestly would look like he had something contagious so I can understand the freaking out. People barely survive this with care immediately available in a hospital so he really had no hope once it ruptured.
That was my thought too. A portal hypertensive crisis following exertion leading to rupture of varices. I can’t think of much else that would present like that besides maybe Ebola Zaire or something, but that would have a noticeable prodrome and “coffee grounds” in the emesis.
Seems like over the last couple of days this news is posted everywhere. I’m sure this kind of stuff happens every now and again, so why is it being pushed now? What is the purpose? What are we getting distracted from that needs our attention?
Lol what? Dude died from complications with alcoholism. Very common way to go once the liver stops working and your esophagus is fried from years of pouring booze down it.
Well, Business Insider did link to flightradar, which shows that the flight in question (they said this past Thursday, which was the 8th) did in fact divert and return to the originating airport at Bangkok on that day. Which isn't necessarily great evidence, but it's better than nothing.
Any idea what kind of health complication causes blood to gush from your nose and mouth? Sounds insane to watch especially when you can’t leave the immediate area…
Critical care nurse here. The answer is esophageal varices.
It’s the same physiological anomaly as hemorrhoids, except in your esophagus. Swollen, fragile veins caused by increased internal pressure. In the case of hemorrhoids, that pressure inside the veins is caused by straining too much when trying to poo. In esophageal varices, the increased pressure inside the esophageal veins comes from blood backing up from a swollen, scarred, and damaged liver. So we often see esophageal varices in end stage alcohol use disorder.
Horror stories abound in emergency departments and ICUs of having to do CPR on a patient massively hemorrhaging out of their mouth from esophageal varices. As soon as nurses I know saw this report, our immediate thought was, “Yep, varices.”
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.
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.
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?
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.
That setup was subtle and very well done. Bravo @FauxPseudo
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.
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!
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.
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.
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.
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.
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.
Oddly enough, alcohol abuse. It’s called esophageal varices.
It’s basically caused by veins in your esophagus rupturing. The same way you can have veins hemorrhage near your anus, causing hemorrhoids. In your esophagus, it’s usually caused by an enlarged liver putting pressure on the surrounding veins. And an enlarged liver is usually caused by end-stage alcoholism.
So the dude had an enlarged liver, (likely sue to a lifetime of alcohol abuse,) popped veins in his esophagus, and started coughing up massive amounts of blood. The dude likely wouldn’t have survived even if he was sitting in an ER when it happened. By the time it happens, it’s usually too late to fix; The victim will drown in their own blood before doctors have a chance to fix it.
But as a random onlooker with no idea what’s happening, it’s absolutely horrifying to see. It looks like something straight out the beginning of a zombie movie. Hell, even if you know exactly what’s happening, it’s still horrifying to see. But at least if you recognize it, you know it’s not contagious.
Source: Dated an EMT for a while, and she had a patient deal with one right after we started dating. I got morbidly curious, and regret the ensuing google searches.
I forgot the medical term but when you have a REALLY bad liver the blood starts to take other ways to the heart to circumvent it (kollateral paths).
One path is going through your oesophagus so your venes widen very much. With the widening the risk of a rupture starts to increase very much and as soon as it does, there is nothing much that can save you.
I am not saying he got that but the description fits very much on point.
Nah ebola is more of a oozing bloody mass. Gushing isn’t possible because low blood pressure is another complication. Also, late stage ebola this man wouldn’t be walking anywhere. Let alone well enough to be allowed on a airplane.
Disseminated intravascular coagulation, it’s when you get a bunch of clots, that uses up all your platelets, and you bleed out because you can no longer clot.
This wouldn’t explain what caused the bleed in the first place, nor how rapidly and profusely they were bleeding. Esophageal varices is a better explanation
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