- A 63-year-old man died on a Lufthansa flight on Thursday, according to Swiss-German outlet Blick.
- Witnesses told the outlet the man had blood gushing from his nose and mouth.
- The witnesses said passengers were screaming at the sight.
Critical care nurse here. The answer is esophageal varices.
It’s the same physiological anomaly as hemorrhoids, except in your esophagus. Swollen, fragile veins caused by increased internal pressure. In the case of hemorrhoids, that pressure inside the veins is caused by straining too much when trying to poo. In esophageal varices, the increased pressure inside the esophageal veins comes from blood backing up from a swollen, scarred, and damaged liver. So we often see esophageal varices in end stage alcohol use disorder.
Horror stories abound in emergency departments and ICUs of having to do CPR on a patient massively hemorrhaging out of their mouth from esophageal varices. As soon as nurses I know saw this report, our immediate thought was, “Yep, varices.”
https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
There are a few things I wish we could really show the public. The first is how brutally savage and undignified CPR really is. And the second is what alcohol abuse really does to a person.
Chronic malnutrition, brain damage, hallucinations, anxiety, internal bleeding, fluid swelling your abdomen like a water balloon, literal ammonia building up in your blood that we treat by deliberately inducing massive diarrhea. That’s not even mentioning esophageal varices and the increased cancer risk.
Alcohol is a horrifying drug.
May I ask what you consider to be alcohol abuse? Yes, there are papers and sites and all that. I tend towards trusting the opinion of people on the ground a bit more.
I’m a 911 dispatcher, I’ve talked people through CPR countless times over the phone, I have very little confidence that most of them were doing it properly because CPR really is pretty brutal, I’ve taken a lot of CPR classes over the years, and every instructor I’ve ever had has mentioned that if you’re doing it right there’s a very good chance you’re breaking ribs in the process. Unless you’ve actually had training and have an idea how rough it can be I doubt that most people are going to do it hard enough out of fear of hurting the patient.
I’ve luckily never had to do CPR in person myself, although I was once on-scene while it was being performed. I was at a party, someone came inside said they think someone died out front, I went out to see what was going on, came around the corner of the driveway and my friend was already doing CPR on a guy laying in the street who crashed his motorcycle. I know my friend also had CPR training so I let him keep at it, I stood by to relieve him in case he got tired and started counting to make sure he was keeping a good rhythm. I of course know my share of cops, firefighters, EMTs, etc. who have had to do CPR in their line of work, but I don’t exactly press them for any details about it, but I talked to my friend afterwards to make sure he was OK, and he talked about how he could really feel the guys ribs popping as he was doing it.
It was also a pretty good illustration of the bystander effect, when my friend got outside there was already one or two other people pulled over with the accident but not really doing anything, not checking on the guy, not on the phone with 911, just kind of standing there. If you asked them, I’m sure they probably would have said they were blocking traffic with their vehicles or something, but that doesn’t really do any good when the guy needs CPR immediately.
Good question. Gasses certainly expand significantly when ascending to the roughly 5000’ cabin pressure altitude.
Which is readily apparent as the cabin quickly fills with farts. Yes, that’s a thing.
Dissolved gasses in the bloodstream will also be affected by this, though not quite as drastically. Still a thing a though. That’s why you don’t get on a plane (or even hike above 500m) within 24 hours after you’ve been scuba diving.
But if you accidently do, or it’s an emergency and you need to fly, at least for some flights you can ask the flight crew to raise the cabin pressure so you don’t get bent.
So all that said, yes, it certainly could be a possible contributing factor.
