Reasons for hemorrhage post CPR

Published

I was taking care of a lady a while back in the ICU and I decided to wait for some time to pass to ask this question here. It was my first day of clinicals for the semester and what better way to start it off than my own patient coding on me. But something has been bugging me for the longest time, because I just don't understand how it happened.

After my patient was intubated, about 5 minutes later, patient began hemorrhaging out of the mouth. They revived the pt, but things weren't looking so hot for them. When I came back the next day to check up on the pt, I found out that said pt also began hemorrhaging out of the eyes, nose, and ears a few hours after I left for the day. Brain bleed was also found.

No blood thinners were ever administered, but I was told that multiple pumps (somewhere in the ballpark of 8) were being used. Could this simply have been caused by:

-overloading from fluid which diluted the blood so much that it acted as a blood thinner?

-or the fluid forced the blood out?

-or the fluid (or degenerative processes taking place in the brain) manipulated/lost control of vascular permeability to where it just leaked out?

-what could have caused the initial hemorrhage from the pts mouth (before all of the other fluids were started and the brain bleed was identified)?

NOTE: brain bleed was not evident on the first scan. Second scan, there was a brain bleed. Apparently, there was a 2 hour window there.

Up Vote Up Vote ×

It depends upon why she was hospitalized in the first place. Many diagnoses that are serious enough to cause someone to be in the ICU and subsequently code can cause hemorrhaging. Liver disease, septic shock, some type of acute coagulation issue could all be culprits.

The first thing that comes to my mind, however, is DIC.

http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation

ETA: the trauma from the intubation and CPR could have been the reason why the bleeding was first seen in the mouth. It was simply a site of trauma.

Up Vote Up Vote ×
+ Join the Discussion