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Feral-Pierssens AL, Matta J, Rives-Lange C, Goldberg M, Zins M, Carette C, Czernichow S. Health care use by adults with obesity: A French cohort study. Obesity (Silver Spring) 2022; 30:733-742. [PMID: 35142072 DOI: 10.1002/oby.23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Studies on obesity costs have focused on global costs of people with obesity but scarcely investigated their precise use of health care. The aim of this study is to document real-life health care use across obesity classes. METHODS Data of participants with obesity and enrolled in the CONSTANCES cohort were analyzed. Health care use was defined as ≥1 visit to general practitioners, specialists, emergency departments, and inpatient hospital admissions versus none over a 3-year period prior to enrollment and was obtained from the Universal Health Insurance database. Multivariate regression models were conducted and adjusted for comorbidities and social deprivation markers with medical visits as the outcome variables and compared people with class II and III obesity versus class I obesity. RESULTS Out of the 10,774 participants with obesity, 613 (5.7%) had class III obesity, and 2,076 (19.3%) had class II obesity. Compared with participants with class I obesity, class III obesity participants had higher odds of visiting emergency departments (OR = 1.31; 95% CI: 1.07-1.61) and various specialist physicians (pneumologists, endocrinologists, cardiologists) but lower odds of visiting gynecologists (OR = 0.69; 95% CI 0.55-0.87). Participants with class II obesity had lower odds of visiting general practitioners, dentists, and psychiatrists. There was no difference with regard to hospital admissions. CONCLUSION Health care use by people with obesity differs across classes.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France
- IMPEC Federation, Paris, France
| | - Joane Matta
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Claire Rives-Lange
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Université de Paris, Paris, France
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Université de Paris, Paris, France
| | - Claire Carette
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, CIC 1418, Georges Pompidou European Hospital, Paris, France
| | - Sébastien Czernichow
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, CIC 1418, Georges Pompidou European Hospital, Paris, France
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Chan GWH, Chai CY, Teo JSY, Tjio CKE, Chua MT, Brown III CA. Emergency airway management in a Singapore centre: A registry study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:42-51. [PMID: 33623957 DOI: 10.47102/annals-acadmedsg.2020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. METHODS We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. RESULTS There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians' initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. CONCLUSION In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success.
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Affiliation(s)
- Gene Wai Han Chan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
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Yilmaz HL, Özkaya AK, Sarı Gökay S, Tolu Kendir Ö, Şenol H. Point-of-care lung ultrasound in children with community acquired pneumonia. Am J Emerg Med 2017; 35:964-969. [DOI: 10.1016/j.ajem.2017.01.065] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 01/18/2023] Open
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Emergency Medical Service Providers' Perspectives towards Management of the Morbidly Obese. Prehosp Disaster Med 2016; 31:471-4. [PMID: 27492275 DOI: 10.1017/s1049023x16000595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Obesity is a growing epidemic in the United States with increasing burden to the health care system. Management and transport of the morbidly obese (MO) pose challenges for Emergency Medical Services (EMS) providers. Though equipment and resources are being directed to the transport of the obese, little research exists to guide these efforts. To address this, the author of this study sought to assess EMS providers' perspectives on the challenges of caring for MO patients. METHODS An anonymous, web-based survey was distributed to all active providers of prehospital transport of a large, urban, fire-based EMS system to evaluate the challenges of MO patients. The definition of MO was left up to the provider. This survey looked at various components of transport: lifting, transport time, airway management, establishing intravenous access, drug administration, as well as demographics, equipment, and education needs. The survey contained yes/no, rank-order, and Likert scale questions. Data were analyzed using descriptive statistics. The study was approved by the University of Miami (Miami, Florida USA) Institutional Review Board. RESULTS Of survey participants, 71.9% felt the average weight of their patients had increased, and 100% reported to have transported a MO patient. Of calls made to EMS, 25% were only for assistance in the house and another 25% were for non-emergent transport to a health care facility; shortness of breath was the most common emergent complaint. Of specific challenges to properly care for MO patients, 94.4 % ranked lifting and/or moving the patient highest, followed by airway management, intravenous access, and measuring vital signs. A total of 43.8% of respondents felt that MO patients require at least six to eight EMS personnel to transport patients while 31.8% felt more than eight providers were necessary. Greater than 81.3% felt it would be beneficial to receive more training and 90.4% felt more equipment was needed. Of participants, 68.8 % felt that MO patients did not receive the same standard of care. CONCLUSIONS Surveyed participants reported that patient's weights are increasing with all having transported a MO patient. Despite the majority of transports being for non-emergent problems, providers felt more training would be beneficial, that equipment available does not meet needs, and that the MO pose challenges to appropriate patient care. Cienki JJ . Emergency Medical Service providers' perspectives towards management of the morbidly obese. Prehosp Disaster Med. 2016;31(5):471-474.
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Siadecki SD, Frasure SE, Lewiss RE, Saul T. High Body Mass Index is Strongly Correlated with Decreased Image Quality in Focused Bedside Echocardiography. J Emerg Med 2016; 50:295-301. [DOI: 10.1016/j.jemermed.2015.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/19/2015] [Accepted: 07/25/2015] [Indexed: 02/06/2023]
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Gable BD, Gardner AK, Celik DH, Bhalla MC, Ahmed RA. Improving bariatric patient transport and care with simulation. West J Emerg Med 2015; 15:199-204. [PMID: 24672612 PMCID: PMC3966441 DOI: 10.5811/westjem.2013.12.18855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/15/2013] [Accepted: 12/03/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence intervals are presented as appropriate. We determined the magnitude of significant pre-post differences with Cohen’s d. We assessed scale reliability using Cronbach’s alpha and was found to be reliable with scores of 0.83 and 0.88 across pre- and post-test responses, respectively. Results Participants exhibited a significant increase in confidence in performing procedures (p<0.01) and knowledge of bariatric patient management (p<0.001) after the simulation. The current study also found an increase in knowledge of transport, vascular access/circulation and airway management (p<0.001). Participant background showed no effects on these changes. Conclusion This study suggests that simulation paired with a didactic is an effective method of education for paramedics caring for and transporting bariatric patients. The data show a significant increase in knowledge and confidence with a 3-hour training session, irrespective of previous training or experience with bariatric patients. This is the first study of its kind to apply simulation training for the pre-hospital care of bariatric patients.
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Affiliation(s)
- Brad D Gable
- Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Aimee K Gardner
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dan H Celik
- Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio
| | - Mary Colleen Bhalla
- Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Northeast Ohio Medical University, Department of Emergency Medicine, Rootstown, Ohio
| | - Rami A Ahmed
- Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Northeast Ohio Medical University, Department of Emergency Medicine, Rootstown, Ohio
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Kobayashi N, Lim BH. Induction of labour and intrapartum care in obese women. Best Pract Res Clin Obstet Gynaecol 2014; 29:394-405. [PMID: 25441151 DOI: 10.1016/j.bpobgyn.2014.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
The rising incidence of obesity in pregnancy has a significant impact on the provision of health services around the world. Due to the pathophysiological processes associated with the condition, the obese pregnant woman is at increased risks of induction of labour, caesarean section, post-partum haemorrhage, infection, longer hospital stay, macrosomia and higher perinatal morbidity and mortality. Labour is more likely to be prolonged and dysfunctional, leading to the requirements for higher doses of oxytocin and increased risks of operative deliveries and morbidity. A multidisciplinary approach to the planning of antenatal, intrapartum and postnatal care is vital to ensure a safe outcome for the obese pregnant woman and her baby. The need for supervision and attendance by senior obstetric staff is increased, emphasising the need to identify the appropriate place of birth for this high-risk group of women, placing a significant strain on the resources of health-care providers.
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Affiliation(s)
- Namiko Kobayashi
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Liverpool Street, Hobart, TAS 7000, Australia.
| | - Boon H Lim
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Liverpool Street, Hobart, TAS 7000, Australia.
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Abstract
ABSTRACT
Trauma and obesity are large-scale epidemics that can be associated with significant morbidity and mortality. In few studies, it has noted that there is the ‘obesity paradox’ (obesity has been found to be protective against mortality) due to certain causes, i.e. heart failure or cardiovascular disease. Subcutaneous fat can show great variability between individuals and increased subcutaneous fat may be protective against injuries by cushioning the internal abdominal organs against injurious forces in road traffic accidents. Many factors including the body fat distribution, body shape, and center of gravity may play an important role in the different injury patterns and severity of injury between men and women. A better understanding of how obesity influences trauma related injuries not only will help to improve the outcome but also foster the development of interventions to address the most salient and modifiable risk factors to reduce obesity related morbidity and mortality. In present article, we review the relevant literature with special considerations to understand the interactions of obesity and trauma with their impact on patient management and outcomes.
How to cite this article
Agrawal A. Complex Interaction between Obesity and Trauma. Panam J Trauma Crit Care Emerg Surg 2014;3(3):109-113.
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Rosenfeld HE, Limb R, Chan P, Fitzgerald M, Bradley WPL, Rosenfeld JV. Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series. J Neurosurg Spine 2013; 19:101-9. [DOI: 10.3171/2013.4.spine12876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions.
Methods
Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management.
Results
Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues.
Conclusions
Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.
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Affiliation(s)
| | | | | | | | - William Pierre Litherland Bradley
- 4Department of Anaesthesia, The Alfred Hospital and Monash University, Melbourne; and
- 5Department of Surgery, Monash University, Melbourne, Australia
| | - Jeffrey V. Rosenfeld
- 2Department of Neurosurgery, and
- 5Department of Surgery, Monash University, Melbourne, Australia
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Ngui B, McDonald Taylor D, Shill J. Effects of obesity on patient experience in the emergency department. Emerg Med Australas 2013; 25:227-32. [DOI: 10.1111/1742-6723.12065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Bryan Ngui
- University of Melbourne; Melbourne; Victoria; Australia
| | | | - Jessica Shill
- University of Melbourne; Melbourne; Victoria; Australia
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[Emergency rescue XXL. Morbidly obese patient in the emergency medical service]. Anaesthesist 2010; 60:63-70. [PMID: 20922355 DOI: 10.1007/s00101-010-1792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Obesity in Germany is becoming more and more prevalent. Significantly overweight patients (>200 kg) pose an increasing and difficult challenge for emergency medical services, emergency doctors and the hospitals responsible for further treatment. The anatomic and physiological characteristics of patients with extreme obesity must be taken into consideration, particularly the airway, breathing, circulation, disability, exposure and environment of the patient. Furthermore special preparations for medical supplies, concepts and strategies for transport and further treatment in hospital are required. Suitable equipment and coordinated processes are essential for both the safety of the persons involved and the patient's dignity. It is, however, a fact that many organizations and hospitals are poorly prepared for this challenge as the complete infrastructure of a hospital has to be adapted. Emergency transport in a bed should be avoided. Neighboring rescue services must be alarmed at an early stage if the commune concerned does not have adequate means of its own. Politics should guarantee cost-covering remuneration for hospitals and rescue services.
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Affiliation(s)
- James Geiling
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, USA.
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Dargin J, Medzon R. Emergency department management of the airway in obese adults. Ann Emerg Med 2010; 56:95-104. [PMID: 20363528 DOI: 10.1016/j.annemergmed.2010.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 02/01/2010] [Accepted: 03/03/2010] [Indexed: 11/26/2022]
Abstract
Airway management in obese adults can be challenging, and much of the literature on this subject focuses on elective surgical cases, rather than acutely ill patients. In this article, we review the emergency department evaluation of the airway in obesity, discussing anatomy, physiology, and pharmacology. In addition, we describe techniques and devices used to improve intubating conditions in the obese patient. After our review of the relevant literature, we conclude that research in this particular area of acute care remains in its infancy.
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Affiliation(s)
- James Dargin
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA, USA
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Adipositas permaxima in der Notfallrettung. Notf Rett Med 2009. [DOI: 10.1007/s10049-008-1141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Berger E. Emergency Departments Shoulder Challenges of Providing Care, Preserving Dignity for the “Super Obese”. Ann Emerg Med 2007; 50:443-5. [PMID: 17886360 DOI: 10.1016/j.annemergmed.2007.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Singh N, Arthur HM, Worster A, Iacobellis G, Sharma AM. Emergency department equipment for obese patients: perceptions of adequacy. J Adv Nurs 2007; 59:140-5. [PMID: 17543014 DOI: 10.1111/j.1365-2648.2007.04266.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study reports an investigation to assess patients' and nurses' perceptions of equipment adequacy for obese patients presenting at an emergency department and to assess nurses' knowledge of equipment weight limits in the emergency department. BACKGROUND The increasing weight of populations in many societies is a challenge to healthcare providers and facilities. Emergency department equipment, specifically, may be inadequate for patient care. METHODS Two questionnaires were developed. One was administered to 134 emergency department patients with suspected cardiac ischaemia; the other was administered to their respective nurses. Patient and nurse equipment adequacy scores were computed. Patients' self-reported height and weight were used to calculate body mass index. Waist circumference was measured. The data were collected in Canada in 2005. FINDINGS Patient equipment adequacy scores correlated inversely with both body mass index (r = -0.55, 95% CI = -0.70 to -0.41, P < 0.01) and waist circumference (r = -0.62, 95% CI = -0.75 to -0.48, P < 0.01). Nurse equipment adequacy scores were also inversely related to patient body mass index (r = -0.34, 95% CI = -0.50 to -0.18, P < 0.01) and waist circumference (r = -0.40, 95% CI = -0.56 to -0.24, P < 0.01). There was a weak correlation between nurse and patient equipment adequacy scores (r = 0.27, 95% CI = -0.44 to -0.10, P < 0.01). Small minorities of nurses reported accurate knowledge of weight limits for beds, commodes and toilets. CONCLUSION Specialized equipment and staff education are needed for adequate management of obese patients in the emergency department.
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Affiliation(s)
- Navneet Singh
- Honours Program/Cardiovascular Obesity Research and Management, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Abstract
Obese persons are more likely to be involved in vehicle accidents, probably because of the presence of sleep apnea. They are more likely to suffer chest, pelvis, and extremity fractures. Mildly overweight persons are less prone to intra-abdominal injury because of the protective effect of the abdominal fat, known as the cushion effect. Obese trauma patients are far more likely to develop in-hospital complications, especially pulmonary, renal, and thromboembolic complications. The BMI is an independent risk factor for morbidity and mortality after trauma. Because only limited data exist about the right clinical approach to obese trauma patients, it is necessary to rely on general knowledge about treating obese patients in the ICU. More research is needed to improve the treatment of obese trauma patients.
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Affiliation(s)
- Yuval Meroz
- Department of Anesthesiology & CCM, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Kiryat Hadassah, P.O. Box 12000, Jerusalem 91120, Israel
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Abstract
This article discusses the unique anesthetic implications of obesity, with an emphasis on children and adolescents. It also touches on the issues surrounding bariatric surgery in the morbidly obese adolescent population. Adolescent bariatric surgery is moving to the forefront as a treatment modality because weight-loss programs alone are not keeping pace with the growth of the problem. Bariatric surgery offers the potential to achieve the weight reductions necessary to reverse the debilitating and costly comorbidities of obesity.
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Affiliation(s)
- B Randall Brenn
- Department of Anesthesiology, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
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