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.
a)
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.
b)
Airway
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).
Breathing
Increased difficulty inserting chest drains.
Possible obesity hypoventilation syndrome.
Increased risk of atelectasis.
Circulation
Need for appropriately sized BP cuff.
IV access more difficult so consider early inter-osseous access.
Other
Caution with analgesia.
Clinical signs, e.g. pneumothorax, difficult to detect by palpation and auscultation.
Log rolling requires additional assistants.
c)
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
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