First time CPR - Blood squirting

[usafmedic45]

It was a CPR save, only way I'll find out is if she tells one of our members I guess.

Just because they made it to the hospital with a pulse does not mean it's a save. Two words: Terri Schiavo. So let me rephrase my earlier comment, "Once they do an autopsy...."

 

[epipusher]

Wow, I don't blame you for lurking after reading a couple of these replies.

 

[Jon]

Long time lurker first time CPR so I thought I would share.

About an hour ago a cardiac arrest call went out right down the street from me. I arrived first with the police and we went into the house and started CPR. We delivered a shock inserted an OPA, at about this time the medics, duty crew and a few members arrived. The medics immediately hooked the pt up to the EKG and intubated her. A few minutes later I saw blood coming from her mouth and could hear the blood in the tube when I was doing chest compressions. This is where it all gets interesting.

We delivered another shock and a bunch of blood squirted from her mouth. One of the medics re-evaulated lung sounds which where 'clear'. CPR was continued and the intubation tube was constantly needing to be suctioned. The next time we shocked the pt blood squirted out 2-3 feet into the air from the tube. We ended up getting a pulse after a few more shocks and few more squirts of blood.

I've only been an EMT for 6 months and this is my first time doing chest compressions. It was just a little freaky seeing all of the blood and especially the squirting from the tube during the shocks.

So expect the unexpected! And know where your face masks are.

I have no idea. If it's in the airway, I can only come up with blood from trauma (airway management including intubation and/or post-arrest fall). If the tube was in the esophagus, I'd think varacies.

There would have likely been a lot more blood than what was described. The last varices case I worked looked like a scene from Kill Bill.

Amen. Only ever had one. I've NEVER seen THAT much blood.

From the sounds of it, you may have gotten ROSC, survival to discharge is another matter.

Even then your medical director can request the records for QI/QA purposes.

Calling it a CPR save because they got to the hospital with a pulse isn't a good measure of cardiac arrest survival. If you give a rock enough Epi, you'll get a pulse... that doesn't mean the rock is alive (Stolen from my first paramedic instructor, credit to CB). To truly be a "save" they need to survive to discharge, preferably neurologically intact.

Not sure which squad you're with. If you have an active medical director, I'd seek him (or her) out and ask about this call. Have them look into it as a learning tool. If you don't, talk with your squad folks and consider reaching out to the QA/QI/Education staff of the MICU project. They will likely be able to get some answers for you.

 

[imadriver]

I've only seen one thing like this. Lots of blood in the tube, and it came up with every compression. What we figured out is when the Medic intubated, we was a little excited and caused it from a rough intubation.

 

[usafmedic45]

There are things that can cause massive apparent pulmonary hemorrhage. A pulmonary AVM comes to mind but it's so uncommon as to be highly unlikely in this case. Likewise with an aortoesophageal or a vascular fistula involving the trachea.

 

[RocketMedic]

And the 'clear' lung sounds complicate a lot of those differentials. Rales/bloody secretions would make a lot more sense, but if they weren't there, who knows?

 

[mycrofft]

Blood is like snakes, and oesophagae are not trachea.

1. When someone tells me how long a snake is, or when I estimate it, I divide by two and add one third of the remainder. Blood loss is tricky to tell on scene, especially if it is potentially mixed with saliva or other pulmonary secretions, or rainwater, sweat etc.

2. Never heard of or saw a tracheal varix, and a lung bleed in an apneic unconscious pt would not ordinarily be magically defying gravity and physics to be "shooting out". Eosophgeal varix: blood all over all the time, not just on shocks.

My vote is oropharyngeal bleeding due to primary and/or airway access trauma (it happens, relax) and/or buccal or lingual injury, mixed with saliva and secretions and expelled in a cough, maybe powered by thoracic muscle spasm secondary to defibrillation. It pooled, then was blown outwards.

Things get confusing sometimes, and even if someone sees it wrong, they need to stick by their observation ("I saw XYZ") but concede that it could have been due to something they don't know about (don't guess and claim at mechanisms you can't assess).

 

[jparent]

Just wanted to update in case anyone cared, the pt went back home a week ago. She spoke with one of our members and is a little distraught about the whole incident. Apparently we (probably me) broke a rib and it punctured a lung. I don't know 100% but its what I heard down the grape vine.


thanks

 

[ArcticKat]

Well, congratulations are in order. Too bad she's pissed about a broken rib (dislocation of which is a common side effect) Hopefully if she decides to sue the judge will take into consideration what the end result would have been had you not done CPR. Too bad the medic didn't catch the pneumothorax when he checked lung sounds.

 

[jparent]

Would broken ribs cause the same type of bleeding? First time doing chest compressions so I have nothing to compare the feeling of the Pt's rib cage to but a few times during compressions the chest didn't rebound instantly, I paused for a second for the chest to rise and continued like normal.

I posted this on the first page but nobody responded. I didn't feel anything 'pop' but it definitely started to feel different after a while, guess it kind of makes sense now

 

[mycrofft]

Looking back:

We delivered another shock and a bunch of blood squirted from her mouth. One of the medics re-evaulated lung sounds which where 'clear'. CPR was continued and the intubation tube was constantly needing to be suctioned. The next time we shocked the pt blood squirted out 2-3 feet into the air from the tube. We ended up getting a pulse after a few more shocks and few more squirts of blood.
Maybe the medic didn't hear any rhonchii due to congestion...naw, I really don't belive this. Sorry.h34r:

 

[firetender]

I've handled traumatic chest injuries, likely rib involvement, where blood did spurt way out of the ET tube. So, we're not talking minor trauma from CPR, but something that the person doing the compressions would almost have to have known if he caused it. During CPR a rib doesn't just happen to snap and get thrust into a lung in other than the old and debilitated. Improper hand placement accompanied by a deep compression is the likely culprit.

Apparently we (probably me) broke a rib and it punctured a lung...
I didn't feel anything 'pop' but it definitely started to feel different after a while, guess it kind of makes sense now

The OP suspects it was he who did it, but, since it was his first experience, I can see how he wouldn't be sure. He DOES, however now know the difference. Stuff like this DOES happen and there could be many, many underlying contributing factors here (like unreported recent rib trauma), so it's all about the lesson.

Bottom line, she lived. Complications go hand in hand with pulling people out of the drain.

 

[mycrofft]

Per my PM with the OP

Maybe what I perceive as "squirting" is not what other people do. Good OP, sparked some good discussions.

 

[Fish]

2-3 feet in the air? Why was the BVM being removed for every shock?

Thats what I am sayin, keep that bad boy on so it stops bloody squirts.

 

[coopera]

Same thing happened to a friend

Sadly we lost our grandfather yesterday.

He was sitting on the lounge, completely normal, then his head fell back and he lost consciousness. My partner got him onto the floor, whilst another person called the ambulance. My partner started CPR then blood started to come from the patients mouth. As CPR continued it seemed to get worse.

I'm not a medical expert by any means, but my partner is feeling pretty down about the whole experience - thinking something was done wrong incorrectly. The Ambulance Paramedics confirmed that the CPR was administered properly yet they too questioned the bleeding. I discussed this with a doctor at the hospital and he told me that breakage of ribs was not likely to be the cause.

After doing some research I found this thread and I was wondering if anyone actually knows possible causes. The patient had a history of heart problems that were controlled by medication. His heart rate was slow and weak - that's all the info I actually know.

 

[Melmd]

The patient had a history of heart problems that were controlled by medication. His heart rate was slow and weak - that's all the info I actually know.

If he's on aspirin or other blood thinners, maybe you can start from there.

 

[coopera]

If he's on aspirin or other blood thinners, maybe you can start from there.

I believe he was on some kind of blood thinners, but I just wanted to know if bleeding like this during CPR is fairly common?

Thanks for your fast reply btw

 

[Melmd]

I believe he was on some kind of blood thinners, but I just wanted to know if bleeding like this during CPR is fairly common?

Thanks for your fast reply btw

I doubt doing CPR caused it, maybe the patient has an esophageal/gastric bleeding that was exacerbated by the blood thinners.