Actual challenge is in diagnosing and managing these patients in emergency set up. Auscultation is one of the most primary physical examination in which findings are going to be altered in a obese patient.
Obesity is one of the leading problems that phcians and technicians face in emergency and tertiary care set up. It not only leads to a number of deadly diseases but also makes the patient management awful for the doctor. This article will enlighten the facts how obesity is a curse to the patient as well as the attending physician in an emergency set up, studies regarding the subject as well as how we can overcome the situation.
Obesity is one of the most common morbid problems in the modern era. It has become a part and parcel of our society. The problem is a lot bigger than it seems to be. It’s about survival and not merely related to fitness only. Obesity is a condition that predisposes an individual to a number of diseases , worsens them and even hinders recovery. It is one of the biggest enemies the emergency department doctors face. It delays diagnosis of a condition, closes a few doors of treatment , carries a number of co-morbidities with it and what not !
In order to counter a problem we must first know what is obesity or overweight? Grossly, accumulation of excessive fat is called obesity but it has a compact quantifiable definition. First we need to have an idea about Body Mass Index i.e Body Weight(KG) / Body Surface Area(m2) A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. The numbers coming up are going to shock you even more. In 2017 , over 4 million people were thrown into the mouth of death just because of this demon called obesity. Such a huge number indicates that the problem has already become an epidemic and not merely a sporadic issue. This monster affects every age group and economical section of the society. From 1975 to 2016, within the span of 40 years the prevalence of overweight or obesity among children and adolescents of age group 5–19 years has increased more than four-fold from 4% to 18% globally. Obesity and Underweight are the two sides of the coin called malnutrition! And the demon of obesity outnumbering the burden of underweight population globally except in some low economic status countries. Slowly but steadily middle income countries, developing ones have taken over the lion’s share of the disease burden. Overweight and obesity are major risk factors for a number of chronic diseases, including cardiovascular diseases such as hypertension, Angina and cerebrovascular diseases such as stroke, which ultimately lead to disastrous outcomes in most of the cases.
Obesity never comes alone. It brings another enemy of the healthcare system called Diabetes Mellitus and its associated conditions, including retinopathy, nephropathy, neuropathy all are clearly on rise having the helping hand in the name of obesity. Rates of diabetes have quadrupled since around the world since 1980.Shockingly the proportion of adults being overweight or obese has increased between 1980 and 2013 from about 29 to 37% in men and from about 30 to 38% in women. Estimated that in 2013, more than 2 billion people in the world were overweight or obese and about 671 million of them were obese. Carrying excess weight can lead to musculoskeletal disorders including osteoarthritis as excessive weight brings about the degenerative changes earlier than normal. Obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, Non Alcoholic Fatty Liver Disease, Cholelithiasis, kidney and colon. Increasing BMI leads to proportional increase in fatality rates of all these non communicable diseases.
The emergency department is where two broken pieces of healthcare meet: obesity and poor access to care. Two recent studies illustrate the results of a phenomenon that weight bias researchers have documented for some time. Overweight and obese people often receive negligence, mocking from some of the health care professionals. As a result, they avoid seeking medical care and frequently switch providers. Numerous comorbid conditions have been associated with obesity, including type 2 diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, and nonalcoholic fatty liver disease. As a result of these comorbidities, the medical costs directly related to obesity are difficult to determine, but a conservative estimate would place the healthcare burden for obesity at approximately $150 billion per year in the United States. Such a mammoth amount actually breaks the economic backbone of a developing country.Increase in mortality is not directly due to obesity but due to the associated conditions it brings. Obese patients present challenging and complex issues in medical and surgical intensive care units. In the current debate over healthcare reform in the United States, no proposed solution can reasonably ignore or minimize the role that obesity plays with regard to economic and health consequences.
Actual challenge is in diagnosing and managing these patients in emergency set up. Auscultation is one of the most primary physical examination in which findings are going to be altered in a obese patient. Most of the times in emergency set up doctors miss important auscultatory findings in these patients that causes the diagnostic delay. ABGs play a massive role in management of a patient coming to the emergency department. In this case the radial artery is the one from which blood is drawn. In case of obese patients, it’s a troublesome job to puncture the radial artery correctly . Securing a central venous line or even putting up a peripheral cannula in some patient needs a mammoth effort if he or she is too obese. While diagnosing a condition radiological limitations and adjustments are also of huge concern. Added on to this ETT and Foley catheter placement is quite difficult. Anesthetic dose adjustment is also a major concern in obese patients and may even lead to disasters if not done properly. Transportation of patients as well as equipments are also a big hazard. Basically every step needs to be placed very carefully in obese patients while managing in emergency set up and a tiny mistake may cost the patients life as well as lead to medico-legal issues.
Such a huge set back in the form of obesity in emergency and tertiary care units needs to be controlled. The only way to decrease obesity is building up awareness among the common people. Government , health care centres have to take up the responsibility to make them understand how deadly obesity can be. Regular counselling in health care centres advertisements can reduce the burden of obese patients on society. Society should be made aware of the necessity of physical exercise and healthy food. But these all are long term processes . Obesity is a global problem. And it’s the high time for the physicians to come up with some plan that helps them manage the obese patients in emergency set up. Dopplar Ultrasound can be a very good option while managing a obese patient in a emergency care unit. Using the technique we can get access to veins, arteries very easily.
Obesity is a global problem. And it’s the high time for the physicians to come up with some plan that helps them manage the obese patients in emergency set up.
This aids in quick management and avoids multiple pricks to the patient. In spite of using fixed non-movable beds , if we use beds with wheels , it will be a lot easier to take patients to the CT room or MRI room. Placing them on the machine will remain an issue though. Portable x-ray devices are a good advancements in medical science that helps to decrease the need of carrying the patient always. Still there will be some unavoidable circumstances in spite of all these where transportation of the patient is mandatory i.e operation theatre etc. It is the high time for the national and international health agencies to publish proper guidelines to manage obese patients in emergency set up. Proper infrastructure and trained staff in every hospital will ease the cause. It’s a global issue and every possible effort should be made to improve the quality of the medical support we can provide to obese people in emergency set up. With so much advancement and innovations coming up in health care system we can surely hope that this global problem will be solved soon.
Composed by: “Dr. Mahan Shome likes to study about the recent advancements in the field of medicine that might help mankind in future. Writing is his passion. He hails from Howrah, West Bengal.”