Procedures are more difficult to perform on the obese emergency patient (Table 304:1). Landmarks are obscured or nonpalpable, access is often impaired by excessive tissue, and positioning problems are common. Airway management may be difficult, intravenous access delayed, and investigations cumbersome or impossible to obtain in the obese patient. These factors all contribute to inevitable obstructions to rapid assessment and resuscitation. Having alternative approaches readily available is the ideal strategy. The appropriate equipment, such as the right blood pressure cuff, must be easy to access. Extra personnel are often required, and a minimum of six people is usually necessary to transfer the patient, particularly when cervical spine precautions must be maintained.

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