The Morbidly Obese Patient

Robert J. Vissers Kathleen A. Raftery

Pathophysiology

Cardiopulmonary, „Disease

Pregnancy

Trauma

Procedures

AirwayManaqement

Electrocardiogram, „Analysis

Sphyqmomanom.etry

Puiseoximetry

VenousAccess Lumb,ar„PMncture DiaqnosticPeritoneal, „Lavage Imaging

Equipment., Problems., .S.p,ec.i.ffl,c„.t.o., .§.D„C.a.re Chapter, References

Obesity is the condition of an excessive proportion of adipose tissue to total body weight. It is a common problem in the industrialized world, with approximately one-third of all adults in the United States estimated to be overweight.1 Since body fat is difficult to measure in the clinical setting, body mass index (BMI) is frequently utilized. BMI is calculated by dividing the weight in kilograms by the square of the height in meters. A BMI greater than 28 kg/m 2 defines obesity in both sexes, and morbid obesity is associated with a BMI of 40 kg/m2 or greater.

Morbidly obese patients pose a number of challenges for emergency health care providers. Prehospital care may be delayed due to problems in moving and transporting these patients. Appropriate-sized gurneys may not be readily available. Even providing common amenities, such as hospital gowns or bedpans of adequate size, can be difficult. In addition, the emergency department (ED) staff must anticipate and be prepared for challenges in performing technical procedures. Excess tissue makes access to body fluids and body cavities a formidable task, while performing imaging procedures can be difficult or impossible. Morbidly obese patients may also evince changes in cardiopulmonary physiology and patterns of traumatic injury, which add to the complexity of their care. 2 This chapter discusses these problems and suggests strategies and techniques that will facilitate the diagnosis and management of acute illness and injury in this unique group of patients.

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