Heavy Subjects

Delivery of emergency care to obese patients

 

 
 
 

James J. Augustine, MD | | Friday, January 30, 2009


An EMS unit receives a call to evaluate an ill person. On arrival, the crew finds a man in a third-floor bedroom of a big home. His complaint is shortness of breath, and he's noted to be a very large patient, lying on a very large bed. He's unable to move out of the bedroom, stating his size does not allow him to move through the doorway. He has bathroom access through a doorway that has been crudely widened by carving out one side of the door frame. He says he has no known medical problems but adds that he hasn't seen a physician in about 30 years. A family member is in the house with the patient and verifies his history.

On physical exam, the patient is found warm and diaphoretic. His respirations are labored at 40/min, pulse at 56/min, pulse oximetry reading is 82%. He's placed on 100% oxygen via non-rebreather mask, and his pulse oximetry reading increases to 90%. The crew asks him if he usually rests flat on the bed. He states that a family member had suggested he lie flat, but that position seems to have worsened his breathing. The patient is assisted to a 45_ upright position, and his pulse oximetry increases to 100%. He denies chest pain, nausea, vomiting or syncope. He is on no medications and has no allergies. He says his family brings him food and water during the day.

The physical exam is remarkable for his large size, but the patient doesn't know his weight. The crew estimates his weight to be more than 600 lbs. He has no signs of trauma. His legs are swollen more than would be proportional to his size. He has a rash on his lower right leg, but no other skin ulcers. His neurologic status is intact.

The assessment of this patient indicates he's at high risk for infections, cardiac disease and pulmonary embolism. His respiratory effort has been stabilized by placing him in a more upright position and giving him supplemental oxygen. The patient has already stated that he's too large to fit through the doorway, and he feels too ill to ambulate on his own. The crew now faces a decision regarding treatment and transportation.

Heavier Patients

We've all heard, read and seen the statistics: A significant percentage of the U.S. population is now obese


Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Accessories, Extrication and Rescue, Specialty Vehicles, Vehicle Operations, Special Patients, Patient Management

 
What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Progress

Follow in the footsteps of these inspirational leaders of EMS.
More >

Multimedia Thumb

PulsePoint PSA, San Diego

App will allow trained San Diego residents to respond to nearby cardiac arrest c
Watch It >


Multimedia Thumb

California Beach Lightning Strike MCI

More than a dozen injured in Venice Beach lighting strike.
Watch It >


Multimedia Thumb

New Item on Iowa Helicopter Helps Save Patient’s Life

Supply of blood recently added to LifeFlight helicopter.
Watch It >


Multimedia Thumb

Shooting Inside Pennsylvania Hospital

Early reports of one person dead in Darby hospital.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


More Product Videos >