Awkward conversation last night

[gonzo]

I've had an Asian woman come in with this...she looked like something from the Exorcist rolling down the hall to the resusc bay. She had dark blood shooting from her mouth about 2ft (sitting up on gurney). When we laid her down to get control of her airway, the blood was filling her mouth so fast that two suction setups couldnt keep up with it...I got lucky and go the tube in blindly. We then put in a Sengstaken-Blakemore tube to stop the bleeding...but I think she still died in the OR.

watched dr in the ICU during medic clinicals try to scope a dude with them and i guess they all totally exploded at the same time. projectile bright red blood. this was at 8 in the morning. when i left at 1900 his belly had swollen 5x and was rock hard filled with blood. HR started in the 150s for hours, by the time I left the heart had pretty much had enough and they were letting the family gather while he circled the drain

[davbrucas]

That's the usual outcome. Live by the sword, die by the sword.

[Chili]

That's the usual outcome. Live by the sword, die by the sword.

I think I'd rather die from a literal sword!

[mstng86]

but I think she still died in the OR.

so you don't know what the outcome of a patient is once they leave the ER?

[ram57ta]

I got a healthy dose of the stuff when I had my heart attack. I went from being terrified and in horrible pain to not giving a fuck and finding a rerun of Cheers to be the greatest achievement in American Television.

Wow...I wasn't aware that you had one. How old are you again Alex? You seem awful young to be having a heart attack. Mind if I ask whats the story?

[DON SVO]

That's one of the most difficult things to deal with in medicine. Have to watch a patient go through the stages of death and dying and not be able to do anything due to the patient and/or family's wishes. I respect their decisions, but it's still difficult to watch.

As far as internal bleeding and not doing anything about it...I would have to hear the circumstances to understand that decision. But some patients will not survive surgery so why put them through the painful process? If a patient has the triad of death (acidosis, coagulopathy and hypothermia) then surgery will kill them 100% of the time. I'm not sure of this patient's situation, but there has to be a reason to not intervene with an actively bleeding patient. DNR does not mean Do Not Treat...it just means that if they go into cardiac arrest, that resuscitation efforts are not instituted. But until that point, most anything is fair game.

I know we talked about this when it was happening since I was at your house...

My grandmother was 94 and came down with sepsis. Long story short, they found out that she had had a heart attack within the past year or so and said that, because of the damage done by the heart attack, she wouldn't live through surgery. It absolutely tore me in half to say goodbye to her. Prior to the sepsis, she only had mild Parkinson's and mild Alzheimer's. she still walked 2 miles a day.

[Probie]

LoL...most of my patients laugh at morphine. They want demerol.

When I did my clinicals there were a few drug chasers that could sit there and name painkillers that "didn't work"

[Moose242]

Wow...I wasn't aware that you had one. How old are you again Alex? You seem awful young to be having a heart attack. Mind if I ask whats the story?

I am 24 now, but I was 19 then. The doctors said it was due to a lack of sleep, excessive energy drinks, and the stress of finals. I had just got back from a weekend of camping after school ended and woke up at my parent's house with an intense chest pain. Worst pain I have ever had in my life next to gasoline in my ear.

Had the telltale enzymes in my blood, an EKG that looked like a lie detector test on Obama, and a ton of docs and nurses swarming me. Was in the ICU for 3 days and the hospital for a week. Carried nitro pills for years after that but I recently had a stress test and a cardiac cath and they said I am good and there is no permanent cardiac scarring. Just goes to show you that it can happen to anyone.

[ram57ta]

I am 24 now, but I was 19 then. The doctors said it was due to a lack of sleep, excessive energy drinks, and the stress of finals. I had just got back from a weekend of camping after school ended and woke up at my parent's house with an intense chest pain. Worst pain I have ever had in my life next to gasoline in my ear.

Had the telltale enzymes in my blood, an EKG that looked like a lie detector test on Obama, and a ton of docs and nurses swarming me. Was in the ICU for 3 days and the hospital for a week. Carried nitro pills for years after that but I recently had a stress test and a cardiac cath and they said I am good and there is no permanent cardiac scarring. Just goes to show you that it can happen to anyone.

Wow I guess I'm not doing too terrible then at 41. Do you have high blood pressure? 2 years ago due to a wisdom tooth infection I learned I had high blood pressure, but didn't realize just how bad it was until my sister and mother MADE me check myself into the Baylor ER while visiting my mother in rehab when her nurse checked my BP and with wide eyes told me my BP was 220/168 (explains the headaches I was having). I stopped smoking cold turkey, stopped energy drinks, stopped coffee, completely eliminated salt when possible, and was put on BP medicine. I was able to drop my BP by changing habits so much that my doctor had to take me off one of them becuase my BP was getting too low. Its now fairly normal.

[BradM]

I've had an Asian woman come in with this...she looked like something from the Exorcist rolling down the hall to the resusc bay. She had dark blood shooting from her mouth about 2ft (sitting up on gurney). When we laid her down to get control of her airway, the blood was filling her mouth so fast that two suction setups couldnt keep up with it...I got lucky and go the tube in blindly. We then put in a Sengstaken-Blakemore tube to stop the bleeding...but I think she still died in the OR.

It's caused by alcoholism?

[mstng86]

It's caused by alcoholism?

yes. Alcoholism also causes heart failure and a small penis.

[JP135]

Interested to hear the background of the OP's story.

And DrDave is right; make mine Fentanyl.

[BradM]

yes. Alcoholism also causes heart failure and a small penis.

I guess I'm the exception that proves the rule!

[davbrucas]

so you don't know what the outcome of a patient is once they leave the ER?

Not always. I see a lot of patients every day and don't see them again unless they come back to the ER. Sometimes if there's an interesting case I will follow up on it however.

[davbrucas]

It's caused by alcoholism?

Alcoholism leads to cirrhosis which is the main cause of esophageal varices.