Bariatric Patients

Medic09, BSN, RN, EMT-P · Apr 21, 2009

Quite simply, there is a real limit to what we can do. The money and resources aren't there.

We were recently talking about this, my wife and I. I commented how often I've wanted to go up to one of these really obese people and explain 'if you have a serious trauma or code, we can't help you. We won't find veins for an IV. Central lines will be much harder. You will be terribly difficult to intubate. Air EMS probably won't be able to transport you. You will be much more difficult to ventilate. Even an IO will require a special, longer needle. You have to do something about this NOW.'

helper T cell · Apr 21, 2009

Dear Medic 09,

you know morbid obesity is a medical condition. Do you think these people want to be fat? Pardon me if i misinterpreted your post but it doesn't sound like you have much empathy for these patients. Believe me they knwo they don't fit anywhere. believe it or not not all really fat people are loser binge eaters that haven't tried multiple weight loss stratigies. Maybe they can't afford to get the by-pass or a gastric lap band. I applaud any facility and medical personnel that can accomadate these people. We have special bariatric beds and large b/p cuffs and wheel chairs. Morbidly obese people in my town have to fly out to get a cat scan or MRI. Morbid obesity like alcoholism and drug addiction and mentaly ill pts deserve the same kind of respect and treatment as the rest of us. I understand that it is hard to find a vein on larger folks but it CAN BE DONE. Again I am sorry if I mis -interperted your post. it just seemed a bit harsh.

Editorial Team / Moderator · Apr 21, 2009

I am somewhere between thinking that providing that specialty equipment somehow condones the extreme obesity (just being honest here), and then thinking that we're going to see these people regardless of what we do or don't have, so we might as well be prepared and able to provide the same services to the very large patients. Where do you draw the line, though? I thought a 500-lb weight limit for a CT table was mighty generous, until I had a patient who weighed closer to 600. Arrghh.

This patient broke my heart, seriously. She was such a nice person, and she had been treated as something less than human in other area ERs, which I thought was a real shame.

Medic09, BSN, RN, EMT-P · Apr 21, 2009

Sockeye, my post was harsh. It was harsh because it was blunt; not because it lacked empathy. These people are far more likely to die of trauma or comorbid diseases because their obesity (aside from slowly killing them) complicates all forms of care and transport. And many obese patients do not understand or accept that it is absolutely their number one priority to address their disease. The same might be said for some brittle diabetics, or other chronicly ill patients who put off the dreaded admission needed to then turn to the problem.

The difference is, as I already indicated, that obese patients can't even be successfully treated in many cases with the same modalities we normally use on the other patients. That is simple, cold fact. Defibrillation is more difficult and less effective. Patient transport and crew safety is severely compromised (especially by air) and often not possible. In fact, peripheral IVs often CANNOT be started, short of a venous cut-down. All forms of airway management are much more difficult.

I would only be lacking empathy if I didn't care that this is the case. Instead, I am deeply saddened everytime I see a patient whose treatment is going to more difficult and risky for them and me both.

Medic09, BSN, RN, EMT-P · Apr 21, 2009

she had been treated as something less than human in other area ERs, which I thought was a real shame.

That, of course, is simply inexcusable and reprehensible. Respect and kindness are the few skills that we can apply equally to all patients and presentations.

But the technical difficulties do not just melt away, as you saw.

helper T cell · Apr 21, 2009

Maybe its just me but we have special equipment for lots of different illnesses and conditions. Like where I work we treat alot of alcoholics. It can get pretty frustrating. Of course I don't condone there behavior but I recognize they have an illness and I have taken an oath to treat all people the same and give them the best care possible.

Does it seem to you guys that the obese population is increasing. It does to me. Thanks for starting this thread as it is scary to treat these people because as medic said they are difficult to treat.

PAERRN20 · Apr 22, 2009

I agree that it does seem like the obese population is increasing. And this is sad not only for the patients but the nurses who take care of them as well. Morbid obesity can lead to injuries for the nurses. In an emergency there isn't always the right number of people to safely transfer or transport. This is really true for EMS crews who often operate a 2 man team. I agree with Medic09- these patients often times cannot be successfully treated. Intubation of these people can sometimes be a nightmare.

DuluthMike · Apr 22, 2009

Dear Medic 09,
you know morbid obesity is a medical condition. Do you think these people want to be fat? Pardon me if i misinterpreted your post but it doesn't sound like you have much empathy for these patients. Believe me they knwo they don't fit anywhere. believe it or not not all really fat people are loser binge eaters that haven't tried multiple weight loss stratigies. Maybe they can't afford to get the by-pass or a gastric lap band. I applaud any facility and medical personnel that can accomadate these people. We have special bariatric beds and large b/p cuffs and wheel chairs. Morbidly obese people in my town have to fly out to get a cat scan or MRI. Morbid obesity like alcoholism and drug addiction and mentaly ill pts deserve the same kind of respect and treatment as the rest of us. I understand that it is hard to find a vein on larger folks but it CAN BE DONE. Again I am sorry if I mis -interperted your post. it just seemed a bit harsh.

It is a medical condition that is caused by lifestyle choices. I'd be incline to approach it the same way I would a smoker.

Editorial Team / Moderator · Apr 22, 2009

I'm also a paramedic, and yeah -- sometimes there are just two of us on a call.

I was careful to get plenty of help to move my patient -- we had to roll her stretcher down the hall to the sono room, and it took 3 of us. I pushed her out in a wheelchair when she was discharged, and it took some effort (me throwing all my weight) to get it rolling. Ironic, that she ended up with the smallest nurse in the place. But safety was a big issue.

PAERRN20 · Apr 22, 2009

It is a medical condition that is caused by lifestyle choices. I'd be incline to approach it the same way I would a smoker.

I also agree with this. I still have empathy for these patients, but sometimes all you can do is teach, teach, teach. You really can't help a patient unless they are willing to help them self first.

helper T cell · Apr 22, 2009

It is a medical condition that is caused by lifestyle choices. I'd be incline to approach it the same way I would a smoker.

That is an excellent point and I do agree. I feel though that it is difficult for these people because if i remember right once our body makes fat cells they never go away merely shrink. So when a person tries to make lifestyle changes it can be really hard as most do gain the weight back. i appreciate the care you gave your pt. LuAnn. To be honest with you all this hits close to home for me as my husband is morbidly obese. One thing I have noticed is now a days it does seem like he has been treated better (with more dignity) when he has required medical treatment then he has in the past. Thanks for all of your insights.