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