With respect to the multi-trauma patient with morbid obesity:
a) Outline how the pattern of traumatic injury differs in the morbidly obese from patients with normal body habitus.
b) List the additional factors, occurring as a consequence of the patient's obesity, that need to be considered during the initial assessment.
c) List the pros and cons of focussed assessment with sonography in trauma (FAST) in the assessment of the obese multi-trauma patient.
Lower injury severity scores overall.
More severe extremity injuries.
More thoracic injury.
Less brain injury – controversial.
Longer extraction time may make for higher risk for crush injury.
Increased risk of partial airway obstruction when lying flat.
Possibility of difficult intubation and difficult bag mask ventilation (cervical collar, neutral position, pre-existing signs of airway obstruction, possible sleep apnoea syndrome).
Increased difficulty inserting chest drains.
Possible obesity hypoventilation syndrome.
Increased risk of atelectasis.
Need for appropriately sized BP cuff.
IV access more difficult so consider early inter-osseous access.
Caution with analgesia.
Clinical signs, e.g. pneumothorax, difficult to detect by palpation and auscultation.
Log rolling requires additional assistants.
Bedside investigation avoids transfer to CT scanner.
Technically challenging with difficulty achieving adequate beam penetration and image quality.
FAST is less sensitive than in non-obese.
False positive pericardial collections are more common in the obese.
Change in the pattern of injuries associated with morbid obesity
Influence of morbid obesity on the primary and secondary survey
Influence of morbid obesity of FAST assessment
Bochicchio, Grant V., et al. "Impact of obesity in the critically ill trauma patient: a prospective study." Journal of the American College of Surgeons 203.4 (2006): 533-538.
Diaz Jr, Jose J., et al. "Morbid obesity is not a risk factor for mortality in critically ill trauma patients." Journal of Trauma and Acute Care Surgery 66.1 (2009): 226-231.
Lambert, David M., Simon Marceau, and R. Armour Forse. "Intra-abdominal pressure in the morbidly obese." Obesity surgery 15.9 (2005): 1225-1232.
Boulanger, Bernard R., et al. "Body habitus as a predictor of injury pattern after blunt trauma." Journal of Trauma and Acute Care Surgery 33.2 (1992): 228-232.
Dhungel, Vinayak, et al. "Obesity delays functional recovery in trauma patients." journal of surgical research 193.1 (2015): 415-420.
Ciesla, David J., et al. "Obesity increases risk of organ failure after severe trauma." Journal of the American College of Surgeons 203.4 (2006): 539-545.
Arbabi, Saman, et al. "The cushion effect." Journal of Trauma and Acute Care Surgery 54.6 (2003): 1090-1093.
Evans, David C., et al. "Obesity in trauma patients: correlations of body mass index with outcomes, injury patterns, and complications." The American surgeon 77.8 (2011): 1003-1008.
Fuchs, I., et al. "Vascular Injury in Obese Patients after Ultra-Low-Velocity Trauma." J Anesth Clin Res 5.488 (2014): 2.