21 October 2006

Obesity is a malignant disease

Dr "Bard Parker" over at A Chance to Cut has an interesting abstract of the recent literature surrounding obesity in trauma. It may be from the Journal of Proving the Intuituvely Obvious, but is worth a look. Nobody in health care would even shrug at the notion that really heavy people are a nightmare to care for, simply on a practical basis. This is the first time I have seen severe obesity linked to short-term mortality.

In short, the heavyweights were 7 times more likely to die in hospital than similar non-obese patients with comparable injuries. They had more infections, spent more time in the ICU, had more central lines, more episodes of organ failure, and spent longer on a ventilator. (To which anyone who has spent time in an ICU responds "duh.") Intubations and tracheostomies are more difficult, and central line placements are more challenging in the obese.

I can vouch for that personally. I am pleased to report that I have three succesful, first-pass intubations in 500+ pounders in the last two years. (One survivor.) Last year we had a young man in his early twenties who weighed over five hundred pounds who expired after a motor vehicle accident. To this day I do not know what his injuries were. He did not fit in the CT scanner, so we had no real way of assessing him. He died of respiratory failure right in front of our eyes. It was terrible; he came in awake, talking and very afraid. He could only breathe sitting up, and even then his respirations were ineffectual. He slowly became somnolent. After great deate and with great trepidation, we intubated him, successfully (no simple matter). But we were unable to ventilate him effectively, and he coded and expired. I would presume there were internal injuries which contributed, but we were never able to ascertain that. It was a bad thing.

It seems like we see more and more of these cases as time goes on. Sad.

3 comments:

  1. That is very sad.

    I would imagine that someone that weighs 500 pounds hits the steering wheel or other parts of the interior with much more force in an accident then someone that weighs less.

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  2. And that's why I go to the gym!

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  3. Wired had an interesting article on obesity as a disease.

    The Thin Pill

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