suicide attempts

[Greenbbs]

anyone have any good stories about people who actually meant it instead of being a gesture like cutting behavior or taking 4 benadryl to escape?

i took care of a patient today who got in a fight with his g/f. he had a history of suicide gestures by cutting behavior, but never really posed a serious threat in the past (per his chart).

well, today, he got into this fight, barricaded himself into his car, and had a 4 hour standoff with the cops. when the cops told him if he didn't come out of the car, they'd break the window and get him out, he told them he'd kill himself by cutting his arm....and by damnit, he sure tried. he raised his arm up to the cops, took out a box cutter, and buried the blade LONGITUDINALLY from about 2 inches distal to the AC to about 4 inches from the wrist.

the cops then broke the window, tased him 4 times, and brought him in to be evaluated. hand surg had to explore the arm, and he only damaged muscle....missed the arteries and nerves by just a bit (blade didn't go deep enough).

he's one of the few patients i've seen lately that actually meant it (with an attempt....)

anyone else have any stories?

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[southerndoc]

A few years ago I had a patient present obviously ill-appearing, jaundiced, complaining of extreme abdominal pain. She said she was depressed and suicidal and wanted to commit suicide. She took 300 650 mg acetaminophen tablets (almost 200 grams!) three days prior. She was having intense RUQ abdominal pain and was wanting pain relief before she died. Her coags and LFT's were through the roof, and sure enough, she died.

 

[EctopicFetus]

I have a couple.. one was a 65 y/o lasy who took a few tylenol about 24 hours prior to coming in along with some lisinopril and other pills she could get her hands on.. Well her APA was like 250 (24 hours after).

The other was a guy who OD'ed on his psych meds.. well he was on geodon effexor and something else not so serious.. well he looks ok, then 10 mins later looks like crap, i tube him, i talked to his wife and he had previously OD'ed on lithium but she assured me he wasnt taking this and that it wasnt in the house anymore.. well his lithium level was 7.

Another was a 40-ish guy who called his sister then hung himself.. he did it like a champ came in code arrest, we flogged him a bit and never regained vitals and then pronounced him. OUt of the 2000 psych patients I have seen a handful of them were very serious about ending it. I would take em all seriously.

 

[WallowaWanderer]

Haven't even started residency yet and I've seen three cases

CO poisoning

Hanging - prehospital case, arrived while the body was still warm and there were agonal beats on the ECG)

TCA Overdose

Sad cases.

 

[Chronic Student]

When I was a scrub tech student one of the first cases I did on my rotations was a guy who was so depressed he stuck a shotgun to his face and pulled the trigger. The story was that his wife was very overbearing and would never let him get in a word edgewise and he was trying to escape her.

He ended up blowing off the front part of his face and could not talk because he was so messed up.

His wife was right there by his side in the ICU telling him how he had even ****ed this up and she, according to the residents, would just constantly berate him while he sat in the bed and could not escape her.

Talk about hell on earth.

 

[ditch doctor]

When I was a scrub tech student one of the first cases I did on my rotations was a guy who was so depressed he stuck a shotgun to his face and pulled the trigger. The story was that his wife was very overbearing and would never let him get in a word edgewise and he was trying to escape her.

He ended up blowing off the front part of his face and could not talk because he was so messed up.

His wife was right there by his side in the ICU telling him how he had even ****ed this up and she, according to the residents, would just constantly berate him while he sat in the bed and could not escape her.

Talk about hell on earth.

When I was a paramedic I had a similar case, a guy that aimed to shallow. Someone told me this is from putting the shotgun directly on the chin instead of a few inches away from your head. Evidently the high pressure air from the barrel blows your head backward a bit before the shot hit you, ergo the blowing off of the face. Don't know if that's true or not, but it sure sounds plausible...

 

[docB]

As you guys know it’s pretty hard to off yourself with pills unless you do it just right. I had a guy once who really made a good attempt. He was a young guy, in his 20s. He went to a convenience store at 2210 and bought a 750 mL bottle of vodka and 144 (12 boxes of 12) 25 mg Benadryl. How do I know that? EMS brought me the bag with the receipt, the empty bottle and the empty foil packs the patient got the pills out of. Sometime between 2210 and 0200 (when EMS was called) he drove out to a deserted stretch of road by the airport and got it all down. At 0200 an airport security guard spotted him slumped over the steering wheel and called EMS. I tubed him in the ED and had to deal with all the usual anticholinergic stuff. He lived but it was a really good try.

 

[EctopicFetus]

oh ive seen a bunch of gsws to the face.. thats not the way to do it.. i assure you.

 

[deleted109597]

Jumper-except he landed on his feet. B calcaneal, open tib/fib, and hip fx. Probably made him more depressed to be immobile than he was before he jumped.
I hate trauma....

 

[deleted109597]

When I was a paramedic I had a similar case, a guy that aimed to shallow. Someone told me this is from putting the shotgun directly on the chin instead of a few inches away from your head. Evidently the high pressure air from the barrel blows your head backward a bit before the shot hit you, ergo the blowing off of the face. Don't know if that's true or not, but it sure sounds plausible...

I've seen a guy that blew off the left side of his face after putting it under his chin. The mechanics of pulling the trigger with the right, and holding the barrel with the left, combined with the gas discharge moved his head to his right. So he had no left to his face. Didn't see it acutely, saw it ~10 years out. Kinda weird. Had one working eye, most of his nose, and a misshapen jaw, but lived.

 

[GeneralVeers]

20 year old guy with a wife and two kids. Got depressed, so took a rifle and shot himself in the chest. He came in barely alive, then coded. He got the ED thoracotomy from the trauma surgeon, and she closed up the hole in his LV. They took him up to surgery and the cardiothoracic surgeon fixed up the rest of the damage.

He walked out of the hospital two weeks later.

 

[gutonc]

We've had a spate of them in the ICU this month.

1. 38yo bipolar woman took 20g of thorazine. 14th suicide attempt in last 4 years.

2. 25yo biochem PhD student who manifested his first psychotic break as a 2 month drinking binge (2 cases of beer a day) then took 250g of tylenol, drank a bottle of bleach, a bottle of **** and span and a bottle of simple green. AST peaked @ 42K, tylenol level 18h after ingestion was 327. Died.

3. 28yo woman, alcoholic tried to stop drinking, got DTs, took 125g of tylenol and a bottle of Aleve as well as bottle of bleach (we need to come up w/ a name for the tylenol/bleach cocktail as it seems popular these days). Tylenol level on admit was ~250 and her AST peaked @ 20K but she pulled through. She and #2 were in adjacent rooms in the unit and she came in the day that we tubed him and started Mr. Kidney. I basically told her that she was going to die...happy to have been wrong on that one.

 

[Apollyon]

1. GSW to head (enter R temple, exit L parietal) - brain leaking out, but took a while to die in the ED

2. Drank a gallon of antifreeze, and something else (I forget what, but we coded this lady for almost 3 hours - GI bleed, too, and it was back-and-forth, back-and forth)

 

[nonesuchgirl]

2. 25yo biochem PhD student who manifested his first psychotic break as a 2 month drinking binge (2 cases of beer a day) then took 250g of tylenol, drank a bottle of bleach, a bottle of **** and span and a bottle of simple green. AST peaked @ 42K, tylenol level 18h after ingestion was 327. Died.

Is the * above s-p-i-c? I didn't know they still made that.

People keep telling me that psychosis starts manifesting in the 20's. I'm not sure if they're trying to scare me back to grade school or what.

 

[Painter1]

Case 1: 70something-year-old asian man, came in with lacerations to bilateral wrists, ACs, and laceration acrosss his neck. On intubating the patient, he vomited pine sol. Countless Rx bottles where empty in his room per EMS. Interestingly, and outrageously, the family denied he tried to kill himself, they insisted he fell down a flight of stairs!

Case 2: 40something year old guy, shot his wife to death, then turned the gun below his jaw to blow his brains out, he missed his brain, breaking his jaw in various pieces. He was chained to the bed in the ICU under police custody. Talk about nightmare.

 

[Chronic Student]

Forgot about this one.

Suicidal middle-aged man drives car onto railroad tracks in front of oncoming train.

Came into ED with massive head and other assorted trauma.

Everytime they would pump on the chest blood would start flowing out of both of his ears.

Completed attempt.

 

[vtucci]

We've had a spate of them in the ICU this month.

1. 38yo bipolar woman took 20g of thorazine. 14th suicide attempt in last 4 years.

2. 25yo biochem PhD student who manifested his first psychotic break as a 2 month drinking binge (2 cases of beer a day) then took 250g of tylenol, drank a bottle of bleach, a bottle of **** and span and a bottle of simple green. AST peaked @ 42K, tylenol level 18h after ingestion was 327. Died.

3. 28yo woman, alcoholic tried to stop drinking, got DTs, took 125g of tylenol and a bottle of Aleve as well as bottle of bleach (we need to come up w/ a name for the tylenol/bleach cocktail as it seems popular these days). Tylenol level on admit was ~250 and her AST peaked @ 20K but she pulled through. She and #2 were in adjacent rooms in the unit and she came in the day that we tubed him and started Mr. Kidney. I basically told her that she was going to die...happy to have been wrong on that one.

How much damage did the bleach do?

 

[gutonc]

How much damage did the bleach do?

Bleach was far and away the least of his problems.

 

[dchristismi]

70 something gentleman, commented to family that someday he might just decide to euphemestically "get out of here." Waiting until family gone the following day, sat down on front porch and shot himself in one temple, hole out the other. Came in agonal, and we didn't work him too long. Found out talking to family that he'd been told he had terminal renal CA and had hinted that he didn't want to be a burden. They were shocked, but couldn't have stopped him. Daughter said that she was sure he did it on the porch so there wouldn't me a mess to clean up in the house.

 

[kungfufishing]

dont remember the exact number, but a young guy showed up after injecting over 1,000 units of his 70/30 a few months back. He lived, but a strong effort nonetheless.

 

[RxnMan]

Once saw a guy who put a gun to his temple and, as he was pulling the trigger, decided that he didn't really want to do it, and angled the gun forward. Bullet ended up richoceting around the inside of his head, leaving bits of lead that showed up on CT.

Not a "good" story, but good did come out of it: he was an organ donor.

 

[Mighty Mouse]

i've had a few so far this year....

guy in his 20's back from iraq and suffering some serious depression. decides to off himself by shooting himself in the face, barrel under chin. missed somehow and blows off the entire front of his face. guy lives. has facial reconstruction but looks all jacked up. some of the new skin rotted. it was nuts. the thing i can't get out of my mind is how is parents looked when i walked into the ICU to round on him the next morning.

2 weeks ago had a guy OD on 50 alpha-one blockers and alcohol. he's initially awake and alert. he says to me, "doc, you know what the worst thing in life to be is?" I say, "what?" He looks me dead in the eye and goes, "alive."

we do a gastric lavage with 9 liters and are still getting fragments. he starts getting drowsy, and then his eyes roll back in his head, he brady's down, has a seizure. i can't bag the guy cuz he's got this giant lavage tube in his nose, so we pull it, and then his airway is a blood bath. crash tube him. the whole thing blew my mind. it all turned so damn fast. guy is still alive though.

 

[Substance]

20-something year old cluster B girl. Pretty bad life overall.

Finds a bridge and jumps from a ten story height.

Bilateral femur, tib-fib, and ankle, with hip fracture, rib, basilar skull etc.

Surprisingly, there was no damage to any major organs. Nor was there any hemorrhaging. It was purely ortho. She lived.

 

[beanbean]

Tried slashing his wrists - horizontal - didn't get the results he wanted so he...
Stabbed himself in the chest - hit the sternum - damn that didn't work either so he...
Jumped out the window - second floor - nope, not high enough so he...
Ran out into traffic and got hit by a car going about 45 mph

Arrived in Trauma room with superficial self inflicted lacs and I think he might have broken his ankle. 'A' for effort but fortunately no one had ever told him what really works.

 

[AmoryBlaine]

Jumpers are the worst. We had a lady who was like 40 jump from about 60 ft. Various ortho injuries and I think she dinged her liver but by far the worst thing (from a visual standpoint) was that she had a gross, disangulated knee dislocation. Left leg looked normal and the right one took a right angle off to the side at the knee. No vascular injury, she lived. Stuff like that really gets me -- much worse than any cut/stab/slash.

I wonder how people feel about 2 days after jumping and pulling through. If anyone has been in an MVC of decent speed you know how about 2 days later you get the full body ache? I'm imaging this lady had that x10.

 

[deleted109597]

'A' for effort but fortunately no one had ever told him what really works.

That's one of the signs you work in the ED. If you want to teach a class called "Suicide, doing it right the first time."

 

[njac]

That's one of the signs you work in the ED. If you want to teach a class called "Suicide, doing it right the first time."

By the end of our Clinical Toxicology elective we all had our preferred methods.

TCAs if you can make sure you aren't found are the way to go.

Personally, I'd go polypharmacy. Maybe some TCAs, and then a nice benzo/barbiturate combo. But before that, a ton of iron. and hide the bottle.

That way they're too busy treating the positive tox screen and you're too out of it to feel the iron wreaking havoc on all of your organs.

Knew a pathologist who did it that way and decided that was definitely the way to do it.

 

[El Cheba]

Had a lady do the shotgun to the face thing and of course took off her chin and nose. Conscious all the way in fighting the crew trying to help her. I crich'ed and off to surgery. Washed and patched what we could. Few days later I was back in the unit and learned they had to find a new way to restrain her cause she was trying to use the restraints to choke herself. I lost track of her after that. If she didn't succeed this time, I'm sure she has tried again and succeeded.

Another one that meant it, guy was hanging out next to the train tracks and the conductor said he saw him run out in front and lay down on the tracks in front of the train. Needless to say, he was called in the field.

 

[AmoryBlaine]

By the end of our Clinical Toxicology elective we all had our preferred methods.

TCAs if you can make sure you aren't found are the way to go.

Personally, I'd go polypharmacy. Maybe some TCAs, and then a nice benzo/barbiturate combo. But before that, a ton of iron. and hide the bottle.

That way they're too busy treating the positive tox screen and you're too out of it to feel the iron wreaking havoc on all of your organs.

Knew a pathologist who did it that way and decided that was definitely the way to do it.

Ha ha. By the end of my Tox elective all I wanted to tell people was "don't try to kill yourself with tylenol, there are much better, much less painful ways to do it."

I like the barb/iron bait and switch combo. Give them a positive lab test and let the other stuff do the nasty work.

 

[Doowai]

What do you think of Benzo/tca/cyanide?If you were to use a gun, what type and where would you aim? I am thinking pistol that fires shotgun shells inside the mouth after the above mixture.

 

[VA Hopeful Dr]

What do you think of Benzo/tca/cyanide?If you were to use a gun, what type and where would you aim? I am thinking pistol that fires shotgun shells inside the mouth after the above mixture.

The Japanese had great success in WWII with large caliber rifles to the face, fired using their toes.

Now, granted, I'm just a lowly almost M-3 but, assuming you can get it, wouldn't an OD on narcotics be the best way to go? You get the nice feeling, you go to sleep, and then resp. arrest your way out of this life.

 

[Dukes]

Had a bizzare case last year...

Old guy came in by ems fully alert and oriented claimed he shot himself 3 times in the head with a hand gun. He went into his back yard said he fired once, not much happened, then another and another. He said it didn't seem to be working so he gave up went inside and called his son on the other side of the country. Son didn't really believe him but got in touch with 911 and they sent out a unit. EMS brings him in.

He had what looked like a small lac on his left temple of which didn't look like much. We didnt believe his story and couldn't decide what do do with him but we just went ahead tubed him and took him to CT. Shockingly he had 3 bullets in his brain. Went straight to surgery had them taken out and extubated the next day, was completely stable and intact neurologically. A day later he just coded and died.

 

[BRG253]

Fast-acting barbiturates are the best way to go.

 

[BADMD]

What do you think of Benzo/tca/cyanide?If you were to use a gun, what type and where would you aim? I am thinking pistol that fires shotgun shells inside the mouth after the above mixture.

The problem with all those is that they are treatable. You have to act fast, but they are treatable. If you decide to do it with a combo, make sure to use one that has no antidote or therapy.

The GSW might not be survivable, but then why take the other stuff? You have to be awake to pull the trigger right.

 

[turtle md]

That's one of the signs you work in the ED. If you want to teach a class called "Suicide, doing it right the first time."

Shouldn't these instructions be included in their discharge paperwork?

 

[turtle md]

Had a 87 year old guy on Trauma service a couple years ago. Had pancreatic CA and was tired of life. 1st attempt was to drive his car into a tree at high speed. Only had a few broken bones and a grade 1 liver lac. 2nd attempt was to hang himself. Was found by family rather quickly and came in with no serious injuries. 3rd attempt shotgun to face. Blew off half his face, but lived. Months later, after reconstructive surgery is when I saw him. Every morning when I rounded on him, he would ask me to kill him. Worst part is that the daughters were in complete denial about his intentions. Thet swore that he had not wanted to end his life. He had been trying to shoot a bird and missed...

 

[njac]

Had a 87 year old guy on Trauma service a couple years ago. Had pancreatic CA and was tired of life. 1st attempt was to drive his car into a tree at high speed. Only had a few broken bones and a grade 1 liver lac. 2nd attempt was to hang himself. Was found by family rather quickly and came in with no serious injuries. 3rd attempt shotgun to face. Blew off half his face, but lived. Months later, after reconstructive surgery is when I saw him. Every morning when I rounded on him, he would ask me to kill him. Worst part is that the daughters were in complete denial about his intentions. Thet swore that he had not wanted to end his life. He had been trying to shoot a bird and missed...

I hate those stories.

 

[gutonc]

Now, granted, I'm just a lowly almost M-3 but, assuming you can get it, wouldn't an OD on narcotics be the best way to go? You get the nice feeling, you go to sleep, and then resp. arrest your way out of this life.

The "problem" with this method is that, your family finds you, calls 911 and starts CPR. EMS gets there, tubes you, gives you some Narcan, you arouse a little and you get dropped in the ED. ED does your tox screen, gives you a Narcan drip and admits you to the MICU. Narcan drip and Mr. Lung continue until you wake up. CT Head on HD #3 shows diffuse cerebral edema and complete loss of gray-white distinction from your anoxic brain injury but your brainstem is intact so they pull the tube and you keep breathing. Now you get a trach and a PEG (maybe an ostomy and and SP cath so people don't have to clean up after you) and you spend the next 20 years in and out of the hospital w/ catheter related infections.

That sounds super awesome.

 

[EM OR BUST]

I did a forensic path rotation my last month of med school. I think Ive seen pretty much everyway to kill yourself. The weirdest stuff I saw was actually a few tapes the homicide detectives had. He had a guy who shot himself in the head and decided to tape it. I didnt know it was common for people to stay alive foR awhile after putting a bullet in there head. This guy put a bullet in the side of his head, then got up washed the dishes and cleaned the house before he fell to the ground and died. The detective told me he has seen this happen many times. CRAZY STUFF!!! Also my attending told me if he was gonna off himself, a .45 in the mouth was the way to do it.

 

[VA Hopeful Dr]

The "problem" with this method is that, your family finds you, calls 911 and starts CPR. EMS gets there, tubes you, gives you some Narcan, you arouse a little and you get dropped in the ED. ED does your tox screen, gives you a Narcan drip and admits you to the MICU. Narcan drip and Mr. Lung continue until you wake up. CT Head on HD #3 shows diffuse cerebral edema and complete loss of gray-white distinction from your anoxic brain injury but your brainstem is intact so they pull the tube and you keep breathing. Now you get a trach and a PEG (maybe an ostomy and and SP cath so people don't have to clean up after you) and you spend the next 20 years in and out of the hospital w/ catheter related infections.

That sounds super awesome.

And that's why you're the resident and I'm just the medical student

 

[danzman]

I once found an internet discussion board were a bunch of depressed people talked about the best way to kill themselves. It was a sad thing. There were people giving advice on what meds to take and what dosage would be most effective. Also there was a whole section on using guns. About every third page was about someone trying to make cyanide in their basement (?!) just so they could end it all. One way that was discussed was insulin + swimming pool. Hadn’t really thought of that one.

 

[Homunculus]

dont remember the exact number, but a young guy showed up after injecting over 1,000 units of his 70/30 a few months back. He lived, but a strong effort nonetheless.

reminds me of a certain pulm attending we had in medschool who said he'd do it with an OD of insulin/beta blocker. prolly not a bad way to go at all.

--your friendly neighborhood nomograming caveman