Brian K. Parker, MD, MS; Sara Manning, MD; Michael E. Winters, MD, MBA

Disclosures

Western J Emerg Med. 2019;20(2):323-330. 

In This Article

Abstract and Introduction

Abstract

Emergency physicians (EP) frequently resuscitate and manage critically ill patients. Resuscitation of the crashing obese patient presents a unique challenge for even the most skilled physician. Changes in anatomy, metabolic demand, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the crashing obese patient in the emergency department, namely intubation, mechanical ventilation, circulatory resuscitation, and pharmacotherapy. To minimize morbidity and mortality, it is imperative that the EP be familiar with the pearls and pitfalls discussed within this article.

Introduction

Obesity has become one of the nation's leading public health crises.[1] In fact, more than one-third of the adult population of the United States (U.S.) is now considered obese.[2] Obesity is typically defined as a body mass index (BMI) greater than 30 kilograms per square meter (kg/m2). People with a BMI greater than 40 kg/m2 are classified as morbidly obese.[3] As BMI increases, so does the incidence of significant comorbid conditions such as diabetes, obstructive sleep apnea, hypertension, and dyslipidemia. In addition, obesity induces a number of anatomic and physiologic changes that affect resuscitation and emergency department (ED) management.

The emergency physician (EP) is frequently called upon to resuscitate and manage critically ill patients. The obese patient whose condition is unstable, rapidly changing, and requires emergent resuscitation, the so-called "crashing" obese patient, presents a unique challenge for even the most skilled EP. Changes in anatomy, metabolic demand, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the crashing obese ED patient, namely rapid sequence intubation, mechanical ventilation, circulatory resuscitation, and pharmacotherapy. To minimize morbidity and mortality, it is imperative that the EP be familiar with the pearls and pitfalls discussed in this article.

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