Bariatric Patients

Published

I recently had a patient who weighed upwards of 500 lbs. She came into our ER with abdominal pain, but there was no way our CT scanner could accommodate her -- our table limit is 350 lbs, and she wouldn't have fit through the scanner gantry anyway. We called all the radiology departments in the area, and the heaviest weight that could be accommodated (at a facility about 50 miles away) was 500 lbs -- so she was still too heavy for that one. We even called a local animal hospital that specializes in horses, but unfortunately they didn't have a CT scanner. The patient was grateful that we went to those lengths to try to find something for her, but it was frustrating. All our usual tools -- x-ray, sono, etc. -- had such limitations because of her size.

We don't have much in the way of equipment for larger patients ... this woman BARELY fit in our widest wheelchair. We are really ill-prepared for the largest patients. I'm just wondering if other facilities have made special efforts to accommodate the really large patients -- what do your ERs have for the bariatric population?

Specializes in mental health.
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.
Not necessarily - not in all cases.
Up Vote Up Vote ×
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.

Most people who pursue bariatric surgery are rejected because of the psychiatric evaluation.

I know a 40-year-old woman who had to see multiple physicians to get a knee replacement. Her best friend keeps saying, "They wouldn't operate because they said she was too young" and one day, I finally said, "Don't kid yourself - it's her weight." She gave me a dirty look and changed the subject.

This woman is more in the 350-pound range and is actually very active physically, so she does not have diabetes or high blood pressure, but her weight is wrecking her joints and we all know it.

Up Vote Up Vote ×
Specializes in Trauma/ED.

We've had this same issue many, many, times where I work and our table goes up to 450lbs! I had this conversation with the head of our radiology dept asking why we didn't buy a scanner that goes "bigger" and he said the larger ones actually are not as fast and the quality is not as high...does that make sense? There are Zoo's out there that have scanners but not many.

Up Vote Up Vote ×
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.

We have 2 pt's on my floor right now that weigh upward of 500 pounds, and they both have been there for months. We have had to rent special beds, chairs, and other equipment. It is extremely difficult to take care of these patients. it takes 6 or more staff to just pull one up in bed, imagine trying to coordinate that on a busy telemetry medsurg unit.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
it takes 6 or more staff to just pull one up in bed, imagine trying to coordinate that on a busy telemetry medsurg unit.

Some days we're lucky to have even 5 staff members in our entire ER at a time ... including our doc. I was grateful that this patient was relatively mobile and ambulatory.

Up Vote Up Vote ×
Specializes in tele, oncology.
We have 2 pt's on my floor right now that weigh upward of 500 pounds, and they both have been there for months. We have had to rent special beds, chairs, and other equipment. It is extremely difficult to take care of these patients. it takes 6 or more staff to just pull one up in bed, imagine trying to coordinate that on a busy telemetry medsurg unit.

Your facility should look into the availability of air pals from the rental company. I kid you not, when we have 500+ # patients, it only takes me and a tech (with a combined weight of 200#) to pull them up in bed.

Our facility actually has a weight loss institute and is home to the medical practice of two docs who have been doing roux-en-Y bypasses for over a decade...they are even patent holders on many of the devices and materials used in the surgeries in general. We have bariatric rooms on my floor that are large enough to hold all of the equipment, with wide open showers and large bathroom doors. But as far as CT equipment goes, I think we're still pretty much out of luck. As far as I can recall, for the much larger patients, they have to go to one of the large teaching hospitals for a scanner that can accommodate them.

And I hear what someone was saying about emergent care on those who are beyond even morbidly obese. We had a patient code once who weighed over 500#...the intensivist's question upon getting to the room was "What the heck am I supposed to do here?" Which was legit in a way. We blew his IV, couldn't get another one in, there was no way compressions were effective, and it took forever to tube him.

Something I don't understand is why (at my faciltiy at least) "appearing malnourished" rates an automatic nutritionist consult, but being >130% of recommended weight for height (which our computers calculate automatically) doesn't. Yeah, you need adequate nutrition for your body to function normally, but there's so many issues that crop up when you're obese that should be addressed as well.

Up Vote Up Vote ×

I once had the misfortune to nurse a bariatric patient that actually TOOK PRIDE in his weight. He was quite young and obviously ambulant as he had managed to feature on the news for severly bashing up a security guard at a night club. This guy by rights should have been in jail but they excused him because he was too fat and was a HEALTH RISK. They let him go free to be able to do something like that again.

Normally I feel empathy for bariatric patients as I have no idea what their personal circumstances are. I dont judge but I do educate where I can. But ones like him who feel no embarressment or feel like nothing is wrong with their weight really disgust me. :angryfire

Up Vote Up Vote ×
Specializes in CCU, ICU, ED, Home Health.

We have one lady we had to transport 2 hours to a major hospital with a CT scanner that would take her weight and that hospital says when their CT scanner was done they used one at the Zoo. Some major zoo's have equipment for the larger animals that can scan patients 500 lbs and up.

Up Vote Up Vote ×
I once had the misfortune to nurse a bariatric patient that actually TOOK PRIDE in his weight. He was quite young and obviously ambulant as he had managed to feature on the news for severly bashing up a security guard at a night club. This guy by rights should have been in jail but they excused him because he was too fat and was a HEALTH RISK. They let him go free to be able to do something like that again.

Normally I feel empathy for bariatric patients as I have no idea what their personal circumstances are. I dont judge but I do educate where I can. But ones like him who feel no embarressment or feel like nothing is wrong with their weight really disgust me. :angryfire

I've been told that this is not uncommon in child psychiatry. You know, an 8-year-old who weighs 200 pounds, that kind of thing.

Up Vote Up Vote ×

This guy was about 18-25 so old enough to know that being bariatric= not good. And old enough to know how how to manipulate the system with his obesity. Though I can understand young children not knowing any better.

I believe that some of these people need a good talk with a motivationalist, psychiatrist etc to find out what is the cause of their overeating and to find out ways to overcome it. Biggest loser is good in the psychiatry way that it makes people look at themselves and the reasons why they are so unhealthy. Dont agree with the loose huge amounts of weight in a tiny period of time by nearly killing yourselves with exercise type thing though.

Up Vote Up Vote ×
Specializes in CTICU.
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.

How very ignorant of you. Obesity has many causes and contributing factors, not just "lifestyle choices". You can stop smoking by not having another smoke. You can't quit obesity by avoiding food. Perhaps you consider depression a lifestyle choice as well?

Up Vote Up Vote ×
Specializes in tele, oncology.
How very ignorant of you. Obesity has many causes and contributing factors, not just "lifestyle choices". You can stop smoking by not having another smoke. You can't quit obesity by avoiding food. Perhaps you consider depression a lifestyle choice as well?

Ah, you assume that there are no contributing factors to smoking? Like peer pressure as a teen, or seeing your parents do it, or the physical addiction of nicotine? Saying you can just stop smoking by not having another smoke is like saying you can just stop being obese by not eating the wrong diet, which you obviously take exception to. Both are addictions with underlying physical and emotional baggage. Healthier lifestyle choices are difficult, whether is be stopping smoking or giving up that extra 1000 calories a day. Addictions require behavioral modifications, education, and an exercise of willpower, of which I believe Americans in general are woefully short on. Hence the number of Americans with unhealthy lifestyles, regardless of what their vice is.

Up Vote Up Vote ×
+ Join the Discussion