You are all doing a great job and working your fat rolls off being such wonderful caregivers to your patients! But not everyone you see in the ER will have a normal BMI. So here's a quick reminder of how that portion of your patient population might be a little different from the rest!
Remember:
1962: 50% of USA was overweight (that's bad enough but...)
2011: 70% of USA is now overweight with 30% of the USA being OBESE!
Physiological changes:
Clinical considerations
* Airway:
Increased oropharyngeal tissue, neck inflexibility and increased mass; consider LARGER laryngoscope blade to help with extra mass
Difficult BVM; consider UPRIGHT or reverse trendelenberg intubation
Increased risk of ASPIRATION (increased intra-abdo pressure, GE sphincter laxity)
* Breathing:
Restrictive pattern + Decreased compliance + Decreased lung volumes = SMALL RESERVE
Increased airway RESISTANCE (parapharyngeal fat, fibrosis)
Increased pCO2 risk especially with SLEEP APNEA
Vent settings: based on IDEAL body weight
* Circulation:
Hyperdynamic with increased intravascular VOLUME
Increased risk of PULMONARY HTN
Increased atherosclerosis + PROTHROMBOTIC
Difficulty assessing real BP; consider A-LINE early
* Other:
-- Medication DOSING may be altered based on lipophilicity or hydrophilicity
-- Use ULTRASOUND to help with body-limited exam!