Death aboard an airplane

[coffeebythelake]

Man dies mid-flight after breaking out in 'cold sweats' and losing 'liters of blood,' scaring his fellow passengers

A witness told Blick, a German-Swiss news outlet, that "it was absolute horror" and "everyone was screaming" on board the Lufthansa flight.

www.businessinsider.com

Sounds like a decompensated cirrhotic with a massive UGIB. The article made it seem like the doctor on board was useless. Not sure what there is to do in this situation.. not like the airplane have a blood bank or carry the tools of an ICU plus GI lab.

---

Members don't see this ad.

 

[anaesthetic]

Man dies mid-flight after breaking out in 'cold sweats' and losing 'liters of blood,' scaring his fellow passengers

A witness told Blick, a German-Swiss news outlet, that "it was absolute horror" and "everyone was screaming" on board the Lufthansa flight.

www.businessinsider.com

Sounds like a decompensated cirrhotic with a massive UGIB. The article made it seem like the doctor on board was useless. Not sure what there is to do in this situation.. not like the airplane have a blood bank or carry the tools of an ICU plus GI lab.

I’ve seen a couple of GI bleeders die in the ED with good IV access having just been seen, awake and talking normally. I’m sure it was horrifying though.

 

[Dr. Rude]

Man dies mid-flight after breaking out in 'cold sweats' and losing 'liters of blood,' scaring his fellow passengers

A witness told Blick, a German-Swiss news outlet, that "it was absolute horror" and "everyone was screaming" on board the Lufthansa flight.

www.businessinsider.com

Sounds like a decompensated cirrhotic with a massive UGIB. The article made it seem like the doctor on board was useless. Not sure what there is to do in this situation.. not like the airplane have a blood bank or carry the tools of an ICU plus GI lab.

maybe aorta-esophageal fistula.

 

[Beeftenderloin]

Unless they somehow managed to fit a Belmont and an endoscope into that on-flight medical kit, no one was saving this guy.

 

[coffeebythelake]

maybe aorta-esophageal fistula.

But statistically speaking... less likely

 

[caligas]

I heard they had him stabilized but Munich put them on a PACU hold.

 

[okayplayer]

What a nightmare for the poor physician on board. Usually there is an IV kit and 1 liter of fluid. Beyond that, all you can do is tell them to land the plane ASAP.

 

[dchz]

Stop linking behind a paywall!! do us the courtesy of copying and pasting.

 

[Pharmado]

This has to be terrible to witness. Most/all of us have seen this happen in a hospital setting and remember it vividly. Imagine witnessing it on an airplane. This could have been a conference full of world renowned physicians and he’d have still died just as quickly. Nice of the media to make it out like this young doc with no equipment and a language barrier should have done something for him.

 

[narcusprince]

I would second another role of the physician is to have the plane staff isolate the individual. Tell them to land the plane, place the IV, if their is an AED on board get it ready. I recently saw an AED aboard a United Flight. This scenario sounds awful. Maybe someone on board has a sayxthen blakemore tube or maybe the attractive lady in first class has something big and black in her bag that looks like one…..

 

[chessknt]

If someone is having a massive UGIB on a plane and has cirrhosis the best thing you can do is call it and give them some morphine unless they are on their way to get a liver transplant. No point in CPR or an AED--let them die with a shred of dignity covered in coffee ground emesis, dont need to blow out their scleral vessels and break all their ribs and electrocute them too.

 

[mmag]

Stop linking behind a paywall!! do us the courtesy of copying and pasting.

Horror as man dies on Lufthansa flight from Bangkok to Munich

The man was said to have been spitting into a bag when a 'gush of blood' came out of his mouth and nose, splattering the walls of the Airbus A380 aircraft from Bangkok to Germany.

www.dailymail.co.uk

 

[coffeebythelake]

Stop linking behind a paywall!! do us the courtesy of copying and pasting.

Is it behind a pay wall? I don't have membership and I can read the whole article

 

[lymphocyte]

I would second another role of the physician is to have the plane staff isolate the individual. Tell them to land the plane, place the IV, if their is an AED on board get it ready. I recently saw an AED aboard a United Flight. This scenario sounds awful. Maybe someone on board has a sayxthen blakemore tube or maybe the attractive lady in first class has something big and black in her bag that looks like one…..

It's Sengstaken–Blakemore, and an AED would have been utterly useless in this situation, just like the physician who let CPR go for 30 minutes. I'm not sure a dildo would reach far enough, but I admit it's a possibility I've never contemplated.

Another vote for morphine and a curtain for dignity.

 

[aneftp]

Unless they somehow managed to fit a Belmont and an endoscope into that on-flight medical kit, no one was saving this guy.

Does anyone use a level 1 due to the potential for poisoning?? Seems fishy it took them 30 plus years to figure out level 1 has problems.

 

[HemeOncHopeful19]

It's Sengstaken–Blakemore, and an AED would have been utterly useless in this situation, just like the physician who let CPR go for 30 minutes. I'm not sure a dildo would reach far enough, but I admit it's a possibility I've never contemplated.

Another vote for morphine and a curtain for dignity.

I like how the ideas in this thread range from “let ‘em die with dignity” to “grab a big black dildo from grandma in first class and shove it down their throat!”

 

[abolt18]

I like how the ideas in this thread range from “let ‘em die with dignity” to “grab a big black dildo from grandma in first class and shove it down their throat!”

Seriously hilarious. But I'm in the same realm of, let him go. Don't put him and his loved ones and all the others around through the trauma of watching you try to resuscitate a dude who is spewing blood from multiple orifices.

 

[Beeftenderloin]

It's Sengstaken–Blakemore, and an AED would have been utterly useless in this situation, just like the physician who let CPR go for 30 minutes. I'm not sure a dildo would reach far enough, but I admit it's a possibility I've never contemplated.

Another vote for morphine and a curtain for dignity.

The number of people, physicians unfortunately included, that can wrap their head around the idea that chest compression and shocks ain’t doing jack if the tank is empty is astoundingly low.

 

[Beeftenderloin]

Does anyone use a level 1 due to the potential for poisoning?? Seems fishy it took them 30 plus years to figure out level 1 has problems.

We still use a level-1 as part of our standard cardiac set-up. Mostly just as a warmer, but on the rare occasion you need to bang a few in quickly, it works fine. It was supposedly only certain lots that may have been tainted with aluminum, and all those lots were pulled. We have access to Thermacor if we want it/call for it. Thermacor is also the default infuser that gets primed when we initiate an MTP.

Admittedly I’ve never actually used a Belmont, but it seems to be the most popular/well known rapid infuser, hence the reference.

 

[DazedWanderer]

Unless they somehow managed to fit a Belmont and an endoscope into that on-flight medical kit, no one was saving this guy.

Assuming the description is accurate of this guy spewing "liters" of blood, I doubt a scope would even be much benefit given that this sounds arterial. Ive seen this scenario happen in the ICU.

Diagnostic EGD for GI bleed... endoscopists found a clot, his fellow asks "hmm should we leave this alone?" "No it'll be fine" GI doc announces confidently. You know what happens next. Starts to pick at the clot... sudden geyser of arterial blood erupts. Camera lens instantly goes red. Pulls out and cleans lens, goes back in and now all he sees is blood in every direction, camera gets quickly obstructed again. Patient starts to tank. Flustered, he tells his resident to call for a stat IR embolization. Then throws off his procedure gown and briskly scurries away down the hall to the elevator with his tail tucked as pt hemodynamics circle the drain and he just expects anesthesia/IR to take it from here.

 

[chessknt]

Assuming the description is accurate of this guy spewing "liters" of blood, I doubt a scope would even be much benefit given that this sounds arterial. Ive seen this scenario happen in the ICU.

Diagnostic EGD for GI bleed... endoscopists found a clot, his fellow asks "hmm should we leave this alone?" "No it'll be fine" GI doc announces confidently. You know what happens next. Starts to pick at the clot... sudden geyser of arterial blood erupts. Camera lens instantly goes red. Pulls out and cleans lens, goes back in and now all he sees is blood in every direction, camera gets quickly obstructed again. Patient starts to tank. Flustered, he tells his resident to call for a stat IR embolization. Then throws off his procedure gown and briskly scurries away down the hall to the elevator with his tail tucked as pt hemodynamics circle the drain and he just expects anesthesia/IR to take it from here.

I can finish the story--anesthesia/IR magically get the pt through the crash TIPS, give each other a high five, then bring him back up to ICU. Pt lingers on a vent for several days with horrible encephalopathy with declining liver function and eventually dies within 90 days regardless from an infection or kidney failure, usually in hospice after being turned down for a transplant due to active etoh use. What a wonderful use of resources.

THE END.

 

[Iso4ane]

On one hand I highly doubt it was liters of blood (I’m sure we all seen a few hundred mLs of blood hit the floor and the mess it makes), but if it was truly liters of blood, dead god the mess it would make in a enclosed space like an airplane.

 

[Beeftenderloin]

Assuming the description is accurate of this guy spewing "liters" of blood, I doubt a scope would even be much benefit given that this sounds arterial. Ive seen this scenario happen in the ICU.

Diagnostic EGD for GI bleed... endoscopists found a clot, his fellow asks "hmm should we leave this alone?" "No it'll be fine" GI doc announces confidently. You know what happens next. Starts to pick at the clot... sudden geyser of arterial blood erupts. Camera lens instantly goes red. Pulls out and cleans lens, goes back in and now all he sees is blood in every direction, camera gets quickly obstructed again. Patient starts to tank. Flustered, he tells his resident to call for a stat IR embolization. Then throws off his procedure gown and briskly scurries away down the hall to the elevator with his tail tucked as pt hemodynamics circle the drain and he just expects anesthesia/IR to take it from here.

Yes, I’ve seen this play out on every mucosal surface from nare to rectum. Endo can’t fix everything, and IR is great, but neither can they. It’s entirely possible he dies whether he was at 30,000ft or already in hospital.

 

[GassYous]

I don't see why they couldn't just transplant his liver during the flight. Only takes about 6 hours.

 

[deleted1183938]

maybe aorta-esophageal fistula.

That's what I am thinking more of. Or Pulmonary Hemorrhage. The cold sweats don't fit in with GI bleeding from cirrhosis. Also his color? Off or pale/gray or yellow? I am thinking he'd already started bleeding internally hence the off skin color.

 

[GassYous]

That's what I am thinking more of. Or Pulmonary Hemorrhage. The cold sweats don't fit in with GI bleeding from cirrhosis. Also his color? Off or pale/gray or yellow? I am thinking he'd already started bleeding internally hence the off skin color.

Can easily happen with esophageal varices that just bleed especially with the difference in air pressure

 

[deleted1183938]

Can easily happen with esophageal varices that just bleed especially with the difference in air pressure

Yeah. The cold sweats from bleeding internally first then outwards later. Makes sense. But was leaning towards a zebra. Most of the GI bleeders I have encountered from Cirrhosis glow like Yellow Bananas.

 

[Beeftenderloin]

Can easily happen with esophageal varices that just bleed especially with the difference in air pressure

Portal hypertension + 20% lower ambient air pressure can make for some pretty brisk venous bleeding, gradients of ~30mmhg or more.