First time CPR - Blood squirting

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jparent

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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.
 
jparent said:
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.
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Strange. Is it possible the bleeding was caused through oral/airway trauma by the laryngoscopy and ETT tube? or did this patient have something like oesophageal varices?
 
Weird... I wonder if the tube placement was rough on the way in.
 
the_negro_puppy said:
Strange. Is it possible the bleeding was caused through oral/airway trauma by the laryngoscopy and ETT tube? or did this patient have something like oesophageal varices?
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I agree.

Varicies, or Gi bleed.

What color was the blood bright red, coffe grounds?

What was the history?
 
Are you sure it was blood and not bloody secretions?

Codes get real messy around the airway.
 
2-3 feet in the air? Why was the BVM being removed for every shock?
 
The blood was bright red coming out and filled up 1/2 of the portable suction container. The blood only squirted in the air twice, the tube was being suctioned just prior to the shock on both occasions. The other few times it was just kind of leaking everywhere.

Hx - non smoker 50yo, unknown medical history besides that. The pt was sitting at the kitchen table prior to the arrest.
 
jparent said:
The blood was bright red coming out and filled up 1/2 of the portable suction container. The blood only squirted in the air twice, the tube was being suctioned just prior to the shock on both occasions. The other few times it was just kind of leaking everywhere.

Hx - non smoker 50yo, unknown medical history besides that. The pt was sitting at the kitchen table prior to the arrest.
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Ruptured varices.
 
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.
 
CAOX3 said:
Ruptured varices.
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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.
 
usafmedic45 - there was A LOT of blood, I watched a video on youtube of ruptured varices and would say the amount of blood in the suction/on the floor could have been consistent with ruptured varices. Maybe I didn't describe just how much blood came from her mouth, about 2-3 were used to wipe off the pt/floor. It's just a guessing game at this point, thanks for everyones reply!
 
Wouldn't a properly placed tube seal off the portion of the GI track that generally bleeds from varicies? It does sound like my experience with varicies though.

OP please check back in if you find out anything further. After my one and only varicies experience I'm interested to know what you find out.
 
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DIC maybe?
 
NVRob said:
DIC maybe?
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Not from someone with no apparently medical history....that's a zebra. Could have been bleeding from a rough intubation or trauma to the mouth or face from the agonal fall.

More than likely the OP is being dramatic in describing relatively minor bleeding. When in doubt, assume someone is lying or exaggerating.
 
Sorry I missed the no previous hx part. My buddy had a case like this, but his pt had a hx of chronic ETOH abuse.
 
usafmedic45 said:
Not from someone with no apparently medical history....that's a zebra. Could have been bleeding from a rough intubation or trauma to the mouth or face from the agonal fall.

More than likely the OP is being dramatic in describing relatively minor bleeding. When in doubt, assume someone is lying or exaggerating.
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It's always safe to say someone is exaggerating on lying online, i think I'm describing it fairly though. The medic said he's never see that much blood coming out like that before. And I don't know the size of the portable suction container but it filled up half way. Also on the big squirt from the ntt tube it hit the medic that was kneeling by the pt's waist, he had a good amount of blood on his arm/chest from 2-3 feet away.
 
bigbaldguy said:
Wouldn't a properly placed tube seal off the portion of the GI track that generally bleeds from varicies? It does sound like my experience with varicies though.

OP please check back in if you find out anything further. After my one and only varicies experience I'm interested to know what you find out.
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If I hear anything I'll update this thread, thanks for everyone's replies.
 
It's always safe to say someone is exaggerating on lying online, i think I'm describing it fairly though
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That's the rule I live by in person as well. It's basically Occam's razor (the simplest answer is the one most likely to be correct).

The medic said he's never see that much blood coming out like that before. And I don't know the size of the portable suction container but it filled up half way. Also on the big squirt from the ntt tube it hit the medic that was kneeling by the pt's waist, he had a good amount of blood on his arm/chest from 2-3 feet away.
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Well, find out if they did an autopsy and get the medical director to request a copy of the report. That's the best way to find out.

Wouldn't a properly placed tube seal off the portion of the GI track that generally bleeds from varicies? It does sound like my experience with varicies though.
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Not unless the tube in question was of the Sengstaken-Blakemore variety.
 
usafmedic45 said:
Well, find out if they did an autopsy and get the medical director to request a copy of the report. That's the best way to find out
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It was a CPR save, only way I'll find out is if she tells one of our members I guess.
 
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.
 
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