Kinda Disgusting

[rainbowman]

This isn't even a joke, or trolling. It's just, I've been shadowing surgeons for the past couple of weeks, and there are so many-hmm how do I say this nicely-large patients. I mean, our country is getting fatter and fatter. By the time I'm out of school it will oly be worse I imagine. I mean, you watch ER/House et al and they're more often than not operating on some really thin guy-dummy obviously.

I'm not the nicest of people or the most PC, but even I couldn't bring myself to ask the surgeon, especially since he had a bit of a belly. So I guess my question is, in all candor, as an honest, innocent question, what is it like to operate on a heavyset person and how do you tell people they're too ::cough:: big to operate on w/o po ing them?

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[Amgen1]

this is a legitimate concern.

operating on obese patients is much more difficult: operative field exposure becomes much more of a challenge, etc . . .

in addition, obese patients tend to be at high risk for post op complications: PE, PNA, increased stress on abdominal wall leading to hernias, etc . . . .

obesity does significantly increase US health care costs

 

[docB]

In EM I come right out an tell people they're too fat to be properly cared for. I have a little speech that I recite for them and their families:

"Your weight means that we will not be able to get venous access. It will be very difficult to intubate you and CPR will be less effective. You are too large for the tables needed to do CT scans, VQ scans, stress testing or cardiac cath. Regular Xrays will be less useful for you. Your weight means that if you have a life threatening situation, which is more likely due to your weight, you will be more likely to die from it that if you weighed less."

Those are the facts.

Here's another thread about the special ambulances going into service for the ultramorbidly obese: http://forums.studentdoctor.net/showthread.php?t=270024

 

[Winged Scapula]

I'm not the nicest of people or the most PC, but even I couldn't bring myself to ask the surgeon, especially since he had a bit of a belly. So I guess my question is, in all candor, as an honest, innocent question, what is it like to operate on a heavyset person and how do you tell people they're too ::cough:: big to operate on w/o po ing them?

That's not an uncommon situation to have to deal with in the non-bariatric general surgery world. For example, I have seen many morbidly obese patients with large ventral hernias desiring a surgical repair. Because of the risk of recurrence due to their size, we'd have to tell them that we wouldn't operate unless they lost x number of pounds.

Its the rare patient who gets mad, IMHO, when you give them a legitimate reason why you can't operate on them in their current condition. These patients know they're obese and there is no reason you need to be rude to them, but its pretty simple to explain why their weight would make the procedure more difficult, risky and possibly increase their risk of complications, including recurrence.

I wouldn't blame them for getting PO'd if you simply told them they were too fat and sent them away...there is a legitimate reason to be concerned about operating on these patients and they need to be told that. You might consider working on your ability to be nicer and more PC...patients appreciate it, as will you colleagues and there is certainly a way to be honest with patients without being offensive or mean. Remember morbidly obese patients have a problem, a problem which you can help them with (not necessarily surgically) and deserve the same kindness you would give any other patient with a medical or psychological problem...trouble is, mistreatment of the obese patient is well accepted in most circles.

Finally, operating on the morbidly obese does present special challenges...I have often had to stand on two steps to be able to reach over a patient, retracting is more difficult when there is more subcut tissue to get out of the way and of course, occasionally need longer instruments to reach into the depths of the wound. Anesthetic problems with obese patients are well documented, as are the post-operative complications of decreased would healing, increased rates of infection, post-op DVT/PE, etc. Many Surgery centers have BMI limits over which you cannot do procedures on patients because of the attendant risks of operating on the morbidly obese without a significant period of post-op observation.

 

[lsres]

I remember from my surgery rotation a story of abdominal surgery on a very obese person. The surgeon carefully dissected through the layers of fat. He kept going further and further down through the layers of fat until he finally got to….. the operating table.

 

[Bring It On]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

 

[funkless]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

If the fat don't fit, you have to quit. (With apologies to the late J. Cochran.)


Personally, I feel that the problem is that not enough people are morbidly obese, and those that are, aren't fat enough. I'd like to see at least 67% of this country's population (especially those in the lower IQ brackets) hit at least 850 lbs. At that size, they'd be too big to procreate, and too big to fit in cars.

This country has too many stupid people rutting like animals, and think of how nice this world would be if we could convince our dumbest 2/3 to stop screwing. Imagine a country where the roads were unclogged with half-wits turning left from the right lane and piddling along in the passing lane.

In a few years, when the big bucks start rolling in, I'm going to start buying chains of pizza joints and ice cream parlors then sell everything at cost.

 

[Winged Scapula]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

People have been getting into accidents for far longer than CT scanners have been widely available. If the patient won't fit or weighs too much for the scanner (usually a limit of 400 lbs is set), then you revert to clinical skills and other manuevers. If you suspect, based on mechanism, physiological parameters and other signs/symptoms that the person has an abdominal injury, you take them to the operating room and either put a scope in or lap them. Surgeons to be need to think this way because on the oral board exams, the scanner seems to always be broken!

A critically ill unstable patient doesn't go to the scanner anyway, regardless of how much they weigh. In the case of a stable, non-urgent condition which would benefit from a CT scan, the results of which would change your management, patients can be transported to zoos which have scanners with a heavier weight limit. I can say that personally its been a rare situation in which that is needed, but it is an option in areas with large animal zoos.

 

[smq123]

Personally, I feel that the problem is that not enough people are morbidly obese, and those that are, aren't fat enough. I'd like to see at least 67% of this country's population (especially those in the lower IQ brackets) hit at least 850 lbs. At that size, they'd be too big to procreate, and too big to fit in cars.

Yeah, but not too big to have a right to some type of medical attention. So that either means making bigger ambulances, or making a lot of house calls.

 

[pillowhead]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

We had this EXACT issue come up in a conference the other day. Patient needing an urgent CT scan and was unable to fit in the scanner. If they can't fit, you can't scan. Period. End of story. At best you can settle for poorer quality alternatives such as ultrasound or nuclear medicine studies for certain problems. Or you can weigh the risks of treatment vs. no treatment without being certain of the diagnosis such as empirically beginning heparin drip for a suspected PE or taking a patient for an exploratory laparoscopy when you suspect an acute abdomen.

It's very difficult. But if someone can't fit in the scanner, then they can't fit. We aren't magicians--if we were, we would quickly whip up a shrinking potion and do our thing. But alas, we aren't.

 

[funkless]

Yeah, but not too big to have a right to some type of medical attention. So that either means making bigger ambulances, or making a lot of house calls.

I choose option C, my patented "flat-bed fatty ambulance."

Let's face it, how much urgent trauma does your garden-variety 850 lb shut-in encounter? Should we widen our ambulances to accomodate these low urgency calls, or should we....send in the Fatmobile? (Imagine a 1974 flatbed ford pickup truck with Jabba the Hut in the back, cruising to the hospital at a brisk 45 mph...)

 

[funkless]

If they can't fit, you can't scan. Period. End of story. At best you can settle for poorer quality alternatives such as ultrasound or nuclear medicine studies for certain problems.

Something tells me that if they can't fit in the CT gantry, then ultrasound is pretty much out, too. So, maybe we are left with nukes, which is a funny thought: "sorry ma'am, your butt is so wide that we have to go nuclear."

 

[smq123]

I choose option C, my patented "flat-bed fatty ambulance."

Let's face it, how much urgent trauma does your garden-variety 850 lb shut-in encounter? Should we widen our ambulances to accomodate these low urgency calls, or should we....send in the Fatmobile? (Imagine a 1974 flatbed ford pickup truck with Jabba the Hut in the back, cruising to the hospital at a brisk 45 mph...)

That's so wrong. I shouldn't be laughing, I really shouldn't....

 

[dynx]

If the fat don't fit, you have to quit. (With apologies to the late J. Cochran.)


Personally, I feel that the problem is that not enough people are morbidly obese, and those that are, aren't fat enough. I'd like to see at least 67% of this country's population (especially those in the lower IQ brackets) hit at least 850 lbs. At that size, they'd be too big to procreate, and too big to fit in cars.

This country has too many stupid people rutting like animals, and think of how nice this world would be if we could convince our dumbest 2/3 to stop screwing. Imagine a country where the roads were unclogged with half-wits turning left from the right lane and piddling along in the passing lane.

In a few years, when the big bucks start rolling in, I'm going to start buying chains of pizza joints and ice cream parlors then sell everything at cost.

 

[3dtp]

Something tells me that if they can't fit in the CT gantry, then ultrasound is pretty much out, too. So, maybe we are left with nukes, which is a funny thought: "sorry ma'am, your butt is so wide that we have to go nuclear."

...and all that tissue will do a dandy job of attenuating the nuclear decay energy before it can be detected. No signal, no image QED.

 

[docB]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

It's not that you do nothing. It's that what you do will have a much poorer chance of success. This would be the typical scenario:
600 lb 40 M BIBA with severe chest pain, SOB and altered mental status. Pt placed on gurney with O2 by mask. Patient has sonorous respirations because he always has sleep apnea. You know you need to tube patient but you'd like an IV to do RSI. Too fat for peripheral IVs. Neck too fat for an EJ. Thighs with so much redundant tissue and yeasty crusts that fem line a poor choice. Usuing US you might find an IJ but you'll probably need an extra long catheter to reach. So you're working on the line and about then the patient goes fully apnic. Ever tried to tube a 600 pounder? It's tough. While you're trying to lift that massive neck to get a tube in he starts to brady down. You try to bag him back up but there's too much flab. You're now at the can't intubate, can't ventilate situation so you've gotta try to cric. You incise a 5 cm cut and start working your way down to the cric. If you've ever done a cric on an ultra morbidly obese patient you know that the 4 step with the stab doesn't work. You're up to your elbows in the neck trying to find some land marks but it's all fat and blood. While you're doing this a nurse is up on a stool trying to do CPR but is bouncing everywhere and the compressions are totally ineffective. You've got no tube and no line so the nurses are asking if you want to give epi and atropine IM (or actually SQ because you don't have a needle that will reach any muscles). Eventually the guy just dies because you can't do anything, try as you will, because he's too fat.

 

[kungfufishing]

Finally, operating on the morbidly obese does present special challenges...I have often had to stand on two steps to be able to reach over a patient

They dont need to lose weight, you just need to grow taller. Get on that right away.

 

[Winged Scapula]

They dont need to lose weight, you just need to grow taller. Get on that right away.

Will do!

 

[cchoukal]

Someone above mentioned anesthetic complications for the morbidly obese. Certainly, they are harder to mask ventilate, but are often not difficult to intubate (our institution has a very active bariatric surgery program, so we get a lot of practice). Because of their habitus, they routinely have atelectasis at baseline (worse when supine, like on the OR table), which leads to V/Q mismatching, shunting, and hypoxemia. They nearly always have OSA, whether it's diagnosed or not, so success after extubation is always an issue, particularily in the context of exposure to various anesthetic agents (see below). These people routinely require a higher level of post-op care (ICU or stepdown) than a thin person having a similar procedure. This costs a lot of money. They are nearly always difficult to establish IV access in, meaning that a higher percentage require central access, which has a much higher rate of complications and adverse effects than does peripheral IV access. This also costs money. Most of our anesthetic agents are lipid soluble (so they get into brain faster), and as a result, tend to linger in fatter people. This means they wake up more slowly, spend more time in PACU, and have more respiratory events post-operatively, all of which cost a lot of money.

I'm doing my OB anesthesia rotation right now, and the vast majority of our parturients are >100kg. This means their boney landmarks for epidural or spinal anesthetic placement are virtually obliterated. I'm not sure this is more dangerous, but I'll tell you, it's a tremendous pain in the a$$ struggling with a 10cm needle in their backs and having nothing to guide your trial-and-error.

 

[carrigallen]

I've heard of a fat man getting stuck in the gantry, not sure how credible that report was though. Usually you end transporting these people by ambulance to the zoo for their scan, although even then the quality of the imaging is not as good as with a regular habitus.
Most anesthiologists have a max weight, around 350-400 lbs.
The other issue is pharmacology. fat patients have a big volume of distribution, which makes giving them an effective dose of med difficult, and then it takes much longer for the med to clear their system. This is particularly bad for anesthetic agents.

 

[Parthenon89]

actually as an EMT, i've been riding for a little over a year, and yes, we've had some fat ones, some that barely even got through the front doors of their homes, but really, they all fit into the ambulance, i'm sure if there are cases in which the person didnt fit...those cenarios would be 1 in a million

 

[Blade28]

I've seen a lot of big patients in my time at the county hospital...

*Those that couldn't fit in the CT scanner (due to weight or habitus)
*One that broke the angio table due to weight
*Those that require two hospital beds, arranged side-by-side, in order to fit

On a related note, I have to admire those surgeons willing to perform bariatric surgery on the morbidly obese - and we're talking BMIs > 45-60 here. Pretty much your worst surgical candidates - a ton of comorbidities, poor health, extreme deconditioning, and huge peri-op risk for DVT/PE.

 

[Winged Scapula]

On a related note, I have to admire those surgeons willing to perform bariatric surgery on the morbidly obese - and we're talking BMIs > 45-60 here. Pretty much your worst surgical candidates - a ton of comorbidities, poor health, extreme deconditioning, and huge peri-op risk for DVT/PE.

Dude, I hated those surgeons...if only because it was ME who got the calls when the patient was in trouble, or just wanted to talk/cry over the phone about feeling nauseated (usually at 0200). Nothing like a super-obese having a fatal PE at age 35 to make you hate those cases.

 

[Blade28]

Dude, I hated those surgeons...if only because it was ME who got the calls when the patient was in trouble, or just wanted to talk/cry over the phone about feeling nauseated (usually at 0200). Nothing like a super-obese having a fatal PE at age 35 to make you hate those cases.

Or when the patient becomes diaphoretic and tachycardic on the floor 24-48 hours post-op...can you say leak?

 

[Winged Scapula]

Or when the patient becomes diaphoretic and tachycardic on the floor 24-48 hours post-op...can you say leak?

But they never leaked 24-48 hrs post- op because that would make it a decent afternoon hour.

It was always 36 hrs so its around 4 am when you get the call that the HR is 126 and they're febrile and "don't look so good"!

 

[ditch doctor]

A morbid obese patient comes in your ER and has been in a terrible accident, non-responsive and you need to do a CAT scan stat....he won't fit....what is the next step you do....are you saying NOTHING?? You telll the family he was too fat to save??

You don't really send an unstable patient to the CT scanner. You could always do a DPL or a FAST-- well, in theory anyway... a DPL on a 400lb person would be tough, as would a FAST...

 

[parvas24]

bad news is you gotta deal with Overweight patients
good part is it makes them sick and they need you ... you help them and they pay more ....

 

[funkless]

a DPL on a 400lb person would be tough, as would a FAST...

That's why i'm pioneering the "abdominal wall cutdown" technique.

 

[Blade28]

That's why i'm pioneering the "abdominal wall cutdown" technique.

Technically I think it'd be called a "peritoneal cutdown" or something similar.

 

[MossPoh]

I have two favorites from my shadowing experiences.

Bone scans with the morbidly obese are somewhat humorous, albeit concerning. All that tissue somehow makes you think they have a bigger skeleton to handle it. Then you see this tiny little person screaming to get out.

The other involved orthopedic surgeries. They say they don't exercise because their knees hurt, and their knees hurt because they weigh well over 300 lbs. Makes a surgery a pain in the a$$. They always say "Oh, I'll exercise when this knee pain goes away. I just need the surgery"....but you KNOW they rarely will.

Some of the kindest people I have met have been overweight, but situations like this are still frustrating...and I'm not even dealing with it like the people posting on here. It was just my shadowing experiences. I'd say two of the coolest patients I have met as people were morbidly obese. One guy was trying very hard to lose it. He was evicted from his place because he couldn't maintain a job, but he couldn't find a NEW place with wide enough doors to fit his wheelchair. (Extra wide wheel chair)

 

[Tired]

The other involved orthopedic surgeries. They say they don't exercise because their knees hurt, and their knees hurt because they weigh well over 300 lbs. Makes a surgery a pain in the a$$. They always say "Oh, I'll exercise when this knee pain goes away. I just need the surgery"....but you KNOW they rarely will.

One of my morbidly obese patients explained me that she twisted her knee when she was 18, then had no symptoms for 30 years, until it came back in the form of arthritis at age 50.

The 400lbs weight gain in that time, I'm sure, had nothing to do with it at all.

 

[Chulito]

In the case of a stable, non-urgent condition which would benefit from a CT scan, the results of which would change your management, patients can be transported to zoos which have scanners with a heavier weight limit.

Damn. That would be such an embarrassing story to tell once you were released from the hospital.

 

[deleted87716]

In the case of a stable, non-urgent condition which would benefit from a CT scan, the results of which would change your management, patients can be transported to zoos which have scanners with a heavier weight limit. I can say that personally its been a rare situation in which that is needed, but it is an option in areas with large animal zoos.

Something tells me that the zoo might be out-of-network for most insurance plans.

 

[Chulito]

Something tells me that the zoo might be out-of-network for most insurance plans.

Kent, I'm giving you the award for most most frequent use of the winkey face.

 

[MossPoh]

One of my morbidly obese patients explained me that she twisted her knee when she was 18, then had no symptoms for 30 years, until it came back in the form of arthritis at age 50.

The 400lbs weight gain in that time, I'm sure, had nothing to do with it at all.

I think that is what bothers me the most. It is always something or someone else's fault. The lack of accountability and willingness to do something about it. The same applies to smoking and what not as well...but the excuses seemed to be a recurring theme with every obese patient I have met.

I understand that are legit situations where people struggle with their weight and I won't be distraught with them if they TRY....but you have to try. There isn't a magic bullet with this stuff.

It is amazing I spent a week with an orthopedic surgeon and I already heard most of the excuses. I heard maybe one person go "Yea...I have an eating problem and I need to fix it"...it was always "I was walking out of cracker barrel and that darn sidewalk was uneven" or something along those lines. Man...if I am this bitter now...I am screwed later on.

 

[Bring It On]

What to do with morbid obese patients that are in critical need of care....are you telling me that you can't do a "cut-down" to get a line in?? Is anesthesia in the room trying to intubate?? or is it an intern? Put anesthesia in the room and that 600 lb pt. will get intubated....think, people, think!! Someone should invent obese "tools" to deal with these folks...they are coming your way.

 

[docB]

What to do with morbid obese patients that are in critical need of care....are you telling me that you can't do a "cut-down" to get a line in?? Is anesthesia in the room trying to intubate?? or is it an intern? Put anesthesia in the room and that 600 lb pt. will get intubated....think, people, think!! Someone should invent obese "tools" to deal with these folks...they are coming your way.

Is this for real? What's with all the quotation marks?

 

[Winged Scapula]

What to do with morbid obese patients that are in critical need of care....are you telling me that you can't do a "cut-down" to get a line in?? Is anesthesia in the room trying to intubate?? or is it an intern? Put anesthesia in the room and that 600 lb pt. will get intubated....think, people, think!! Someone should invent obese "tools" to deal with these folks...they are coming your way.

Uhmmm....you are raising an "issue" which isn't even an issue.

Obviously you CAN do a cut-down if a patient needs a line, but that wasn't even mentioned here as an issue. If a critically ill patient presents to the ED without IV access, they are most likely getting a central line. While other's experience may differ, I have yet to do a cut down and have placed central lines in 600+ pounders.

While interns are often allowed to intubate patients in emergency situations, in a critically ill patient with a difficult airway, it is most often an experienced person. Hospitals manage these patients differently. If it is a trauma, anesthesia may be there to intubate (as was the case in my residency), in others it may be EM personnel. I'm not sure where you were getting the idea that a morbidly obese patient who needed intubation was not getting that service.

And finally, there ARE tools to assist medical personnel in performing procedures on the morbidly obese. In the OR, the laparoscopic instruments come in a longer version to reach the depths of the abdominal cavity (which the ordinary lap devices can't), there are longer needle lengths, wider beds and wheelchairs, etc.

I'm not sure where you got the idea that morbidly obese patients aren't getting the care they need. While it is true that they may not be able to undergo certain radiological studies or the studies will be compromised by their adiposity, they are still cared for. Remember there was a time, and there are still places in this world, where CT scans and other advanced radiological procedures are not available and physicians had to use good old fashioned history and physical exam to diagnose and treat the patient. It would be dishonest to say that the morbidly obese are not compromising their care by their size, but AGAIN in an effort to answer your earlier question, "no, morbidly obese patients who are in an accident, non-responsive and can't fit into the scanner, are not left alone or untreated."

I'm not sure where in the heck you would get the idea. If you are the Ortho resident you claim to be, you should know this already as surely you have operated on morbidly obese patients or seen them in the trauma bay. Have you read any of the posts since your first one in this thread?

 

[AmoryBlaine]

In EM I come right out an tell people they're too fat to be properly cared for. I have a little speech that I recite for them and their families:

"Your weight means that we will not be able to get venous access. It will be very difficult to intubate you and CPR will be less effective. You are too large for the tables needed to do CT scans, VQ scans, stress testing or cardiac cath. Regular Xrays will be less useful for you. Your weight means that if you have a life threatening situation, which is more likely due to your weight, you will be more likely to die from it that if you weighed less."

Those are the facts.

Here's another thread about the special ambulances going into service for the ultramorbidly obese: http://forums.studentdoctor.net/showthread.php?t=270024

Wow. Kinda harsh, but all 100% true. Obesity is truly a cancer on our society.

The other day on the bus I saw a lady taking up not one, not two, but 3 seats. Her bootay was far to large to be contained in one seat and as she was so round she could not rest her huge purse on her lap like us normal people did. So she was sort of spread out, half-sitting, half-laying across an entire row of seats.

One last story. I saw a hugely fat paramedic the other day with a shirt on that said "Tactical Rescue." Riiiiight, what sort of tactics are those going to be?

 

[Bring It On]

to docB's post on 8-12-07 at 6:20am....that was the post I responded to, not a real patient docB was describing but was sad...thanks for your remarks Kim, I really respect you.

 

[docB]

I'm not sure where you got the idea that morbidly obese patients aren't getting the care they need.

Probably from me. I maintain that these patients can't get much of the care they need. Now there's a difference between just not doing anything and not being able to get imaging, cath or IR and so on due to the person being too big for the table. As Kim said, it's not that we don't care for them. It's that caring for them has to happen without a lot of the stuff we can use to care for non-obese patients. Putting a central line in a 500lber is more difficult and results in more complications than a regular person. I still say that tubing a morbidly obese patient can be tough. These are people who have sleep apnea to begin with, some snore while awake, when they come in in extremis it can be a mess. The previously mentioned bit about the obese not presenting a problem based on someone's experience in a busy bariatric surgery center is not relavent to the ED where patients arrive sweaty, agitated and dyspnic fresh from their last meal.

Of note, just yesterday I had 2 post surgical complications come to the ED and both were, you guessed it, morbidly obese. 1 abdominal wall hematoma in a post hyster patient and one abscess in a post hernia patient.

Here's the frustrating thing. Society understands that these people have increased risk from heart disease, stroke, etc. due to their weight. Most agree that they bear the liability for that (except for the crowd who want to sue McDonalds). Society and the morbidly obese need to understand that they also have increased risk in the hospital due to their weight and that they, not I, should bear the added liability of that.

 

[Bring It On]

You seem like a very caring person...for the skinny or obese

 

[Winged Scapula]

Thanks for the clarification. Sorry if I overreacted to your post.

Obviously I had read docB's post and perhaps had "read between the lines" as I knew he wasn't saying that they didn't get care, but commenting on the very real experience that caring for them, even in a large tertiary hospital, is difficult at best.

 

[Blade28]

Most agree that they bear the liability for that (except for the crowd who want to sue McDonalds). Society and the morbidly obese need to understand that they also have increased risk in the hospital due to their weight and that they, not I, should bear the added liability of that.

Just wanted to add that I found your avatar particularly coincidental.

 

[funkless]

What to do with morbid obese patients that are in critical need of care....are you telling me that you can't do a "cut-down" to get a line in?? Is anesthesia in the room trying to intubate?? or is it an intern? Put anesthesia in the room and that 600 lb pt. will get intubated....think, people, think!! Someone should invent obese "tools" to deal with these folks...they are coming your way.

FYI, there's only so much you can do to resist the laws of physics. If you've ever tried to read a CT with significant fat-induced "ring artifact," you would understand that, as technologically advanced as we are, there are still fundamental limits to our capabilities.

In our time, we have harvested the secrets of the atom itself, but now (and forever) we remain powerless against the laws of nature that dictate its behavior (such as the deflection evoked when projecting a signal through foot-thick slabs of adipose tissue).

 

[funkless]

Just wanted to add that I found your avatar particularly coincidental.

Shoulda been for "Fatburger."

 

[ESPNdeportes]

We still see it, but another reason I'm glad to be going into peds

 

[docB]

Just wanted to add that I found your avatar particularly coincidental.

The avatar is based on the fact that the best residency in EM is at In-N-Out Burger. Just go to the EM forum and ask where the best residency is (or better yet do a search).