Blood from nose and mouth during CPR

Dr Phil

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Volunteer first responder here. Had a CPR call this morning. Early 40-ish year old asian woman, not heavy, not a drug user, no former medical history. Warm and without rigor when she was discovered, but displayed some lividity, so I think she was way dead when we got there. The wrinkle for me is when CPR started, oxygenated blood started flowing from her nose and later filled her mouth and needed to be suctioned out - a fraction of a pint in all - but lungs sounded clear. I'm thinking esophageal varices (in which case I suspect her stomach was full of blood). Any opinion? Needless to say that outcome is what is expected.

BTW, my handle refers to my PhD (physics) - not a medical degree.
 

ThadeusJ

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So no blood thinners or organic/naturopathic blood thinning foods or drink? Its a bit of a reach, but you never know what home remedies people ingest nowadays and some people will go overboard if they see it as a miracle food.
 

Akulahawk

EMT-P/ED RN
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If you're seeing blood initially flow from the nostrils and it's clearly NOT in the airway at FIRST, chances are pretty darned good you're not likely seeing esophageal varices that went boom. You could very well have been dealing with a dead person that had some nasal blood vessels burst upon application of CPR, or insertion of an airway adjunct (like NPA) could have torn something, causing the bleeding you observed.

OF course if nobody actually checked the upper airway for obstructions and there was some blood already in there, application of compressions could cause the blood to squirt out of an open orifice, though I'd expect the mouth would be first as it's an easier passage...
 
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Dr Phil

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So no blood thinners or organic/naturopathic blood thinning foods or drink? Its a bit of a reach, but you never know what home remedies people ingest nowadays and some people will go overboard if they see it as a miracle food.
I don't know if she was taking anything homeopathic. There were no pill bottles in all the usual places (nightstand, purse, medicine cabinet...) But as you point out, we never know.
 
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Dr Phil

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If you're seeing blood initially flow from the nostrils and it's clearly NOT in the airway at FIRST, chances are pretty darned good you're not likely seeing esophageal varices that went boom. You could very well have been dealing with a dead person that had some nasal blood vessels burst upon application of CPR, or insertion of an airway adjunct (like NPA) could have torn something, causing the bleeding you observed.

OF course if nobody actually checked the upper airway for obstructions and there was some blood already in there, application of compressions could cause the blood to squirt out of an open orifice, though I'd expect the mouth would be first as it's an easier passage...
First EMT on scene started CPR without an airway installed, and the blood started immediately. I don't know for a fact, but I think given the patient was found lying unresponsive in bed that obstructed airway was not the first thought in their mind and they may not have checked prior to starting compressions.
 

mgr22

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First EMT on scene started CPR without an airway installed, and the blood started immediately. I don't know for a fact, but I think given the patient was found lying unresponsive in bed that obstructed airway was not the first thought in their mind and they may not have checked prior to starting compressions.
Just curious: Did the EMT notice lividity before starting CPR?
 

Tigger

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Sounds like a good opportunity for remediation.
I think it is somewhat difficult to have low call volume responders differentiate between mottling and lividity and I'd rather have first responders provide compressions until EMS arrives than not...
 

mgr22

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I think it is somewhat difficult to have low call volume responders differentiate between mottling and lividity and I'd rather have first responders provide compressions until EMS arrives than not...
True. Maybe just make sure the EMT knows what lividity is and what it means, but when in doubt, start CPR.
 

GutIvanGuy

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I started CPR on a guy once who had been down for less than 5 minutes (we were around the corner). Blood starting coming out of his nose, and slowly but surely his mouth had began to fill with blood as well prior to any airway insertion. As suction was initiated by my partner, blood also began to flow out of his eyes, eventually having to be suctioned as well.
No blood thinners, or home remedies that we knew of. Just a healthier looking guy in his late 40's.
Needless to say, it was a little creepy seeing little pools of blood covering his eyes.
 
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Dr Phil

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I started CPR on a guy once who had been down for less than 5 minutes (we were around the corner). Blood starting coming out of his nose, and slowly but surely his mouth had began to fill with blood as well prior to any airway insertion. As suction was initiated by my partner, blood also began to flow out of his eyes, eventually having to be suctioned as well.
No blood thinners, or home remedies that we knew of. Just a healthier looking guy in his late 40's.
Needless to say, it was a little creepy seeing little pools of blood covering his eyes.
No blood from the eyes in my case, and it sounds like you had more blood than I did. If the entire airway and sinuses were filled with blood, could you get blood through the tear ducts?
 

RedBlanketRunner

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One possible explanation: Had this one explained to me by a pathologist and I apologize for not remembering his technical terms. It is similar to a shock response where blood tends to pool in the capillaries in the head. Involuntarily autonomic response as the brain tries to oxygenate itself. With all the blood vessels in the head, rupture and massive bleeding can follow. Keep in mind, some of that blood is oxygenated but hasn't been used.

Head injuries bleed the worst as a rule. Where shock can shut down circulation to where a severed limb may not bleed at all, injuries to the head are often the reverse.

I need someone to explain what they mean by lividity. True livor mortis starts about a half hour post biological death, and usually around 2 hours. It's mottled purple and there is no oxygenated blood still present in the circulatory system.


BTW, I once had a patient bleeding on my hands from me doing chest compressions. Some people have extremely thin blood vessel walls which can be cause by dozens of conditions, exacerbated by life style and diet.
 
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