Why so much blood coming from the lungs?

[engine173351]

I'm a paramedic student currently doing field internships. We recently responded to a dispatch complaint reporting a seizure in a park. An engine company arrived before we did and advised that a 48-year old male patient had apparently collapsed, displayed seizure-like activity, and went into full arrest with subsequent bystander CPR. They delivered two automated shocks prior to our arrival and were able to get a return of a pulse. His wife stated that his only medical history was a past CVA.

On our arrival, the patient was unresponsive with agonal respirations and showed sinus tachycardia on the monitor. We got him loaded into the medic unit and prepared to intubate. During this entire time, he was literally spewing blood from his mouth like a fountain (which made us think about the possibility of a GI bleed). When I went in with the laryngoscope, I could see nothing but red. Even after suctioning several times, the blood would continuously pool up again and again. The lead paramedic was able to intubate, which he called a "lucky shot in the dark." After the tube was in place, we found that the blood stopped coming from his mouth and was now shooting up out of the tube onto the floor and cabinets. Even after endotracheal suctioning, the flow wouldn't stop and backed up into the BVM at one point.

The patient arrested a second time in the medic unit. After two shocks, he converted back into sinus tachycardia. We got him to the hospital, where an x-ray showed that both of his lungs had massive pulmonary edema. After asking the attending emergency physician and the lead paramedic, no one seemed to know why a patient would have such a large amount of blood coming from the lungs (estimated to be over a pint from the scene to the hospital). What is your input?

[Arctickat]

Sounds like a Flashover. Left side MI, maybe a PE.

Edited March 28, 2014 by Arctickat

[Just Plain Ruff]

I had this same issue on a patient but the blood wasn't coming from his lungs but from his Esophageal varisces that had ruptured.. He bled out and died.

We were able to intubate him but it was a Gold medal shot in the dark that was successful.

We also had a physician on the ambulance doing a sort of "see what we do" kind of thing and he recommended that we intubate the esophagus as well to provide a conduit for the blood to go. When he went to put the tube in he was able to see (he said he was) the varisces that had ruptured and he tried to tamponade the bleeder by inflating the cuff of the tube. That failed.

The patient succumbed to his illness and that as we say "is that".

[ERDoc]

We grossly overestimate blood loss. Putting a few drops of blood in some water will make the water look like blood. There have been studies (I don't have the time to search for them) that has shown we are horrible at estimating blood loss. This could have been some pulmonary edema with more than average blood, a punctured blood vessel, an aortotracheal fistula, etc.

[Just Plain Ruff]

We grossly overestimate blood loss. Putting a few drops of blood in some water will make the water look like blood. There have been studies (I don't have the time to search for them) that has shown we are horrible at estimating blood loss. This could have been some pulmonary edema with more than average blood, a punctured blood vessel, an aortotracheal fistula, etc.

actually I had a large blue bucket about 1 foot across filled to about 3 inches deep with blood from my guy. I'm pretty sure that he lost a crap load of blood. but you are totally correct. a couple of drops to a layperson means they are dying.

[ERDoc]

It's not just the laypeople.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421978/

http://pediatrics.aappublications.org/content/124/4/e729.full.pdf

http://www.ncbi.nlm.nih.gov/pubmed/10424862

[Off Label]

Intrapulmonary AVM?