Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Heavy Stuff

By David F. Baehren, M.D. | on August 1, 2009 | 0 Comment
Opinion
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

It has been said that no good conversation ever starts with the words, “Remember that patient you sent home?” The other one I hate is when your director approaches you and says, “Hey, I’ve got something I want to talk with you about.” These are rarely positive interactions, and you leave them wondering why you didn’t become a dermatologist or a plumber.

You Might Also Like
  • Heavy Stuff Right From the Horse’s Mouth
  • Tips for Managing Heavy Workloads in the Emergency Department
  • Online Clinical Tool for Post–Bariatric Surgery Patients Could Improve Management
Explore This Issue
ACEP News: Vol 28 – No 08 – August 2009

I’ve also learned that there are many signs that can portend a difficult patient encounter. This can happen when the patient says, “It all started when I slipped on the wet floor in Wal-Mart 9 months ago.” You know life will get exciting soon when the nurse tells you that the lady they just brought in to room 3 is crowning. And there is a more recent phenomenon of eight burly EMTs arriving to unload the patient who is overflowing their gurney.

I predict that the treatment of the superobese will be the next fertile ground for trial lawyers.

We’ve gotten used to the fact that about a third of the population is significantly overweight, and we see them with their orthopedic issues, metabolic syndrome, and sleep apnea. The hospitals have purchased bigger beds, and the nursing units have machines that help them to move the patients. Adjusting to the nation’s growing waistline has been relatively easy.

Dealing with patients with a BMI greater than 50 is another issue. It seems that the number of superobese patients we encounter is off the charts. Just like every other challenge we face, emergency physicians, nurses, and medical technicians adjust and make the best of it. In spite of our can-do approach, it is clear that in most hospitals we have limited resources for caring for those who weigh more than 400 pounds.

I recently cared for a woman who presented with altered mental status. She definitely needed a CT scan of her head, but it was clear that she weighed at least 500 pounds. I guessed 500. One of the nurses guessed 700. I felt like the carnival guy who guesses your age, weight, or birthday. I would have been closer on her birthday.

We finally got a bariatric bed with a scale and measured her at 625 pounds. This is 225 pounds over the limit for our CT, MRI, or angiography tables. I made some calls around the region and found that the biggest limit for CT scanners in our area was 500 pounds. It became clear that there was no easy or quick way to image the head of this woman. She was admitted in the middle of the night, and access to a CT became an issue for the inpatient service to resolve.

Pages: 1 2 3 | Single Page

Topics: In the Arena

Related

  • Oh, I wish I Were an Oscar Mayer Wiener

    December 1, 2013 - 0 Comment
  • The Power of Peace

    November 1, 2013 - 0 Comment
  • Now You’re Just Being Absurd

    September 1, 2013 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

No Responses to “Heavy Stuff”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603