A morbidly obese 49-year-old female is referred from the Emergency Department to ICU following a motor vehicle crash and has left sided fractured ribs and a flail chest. She has seatbelt bruising over her chest wall and abdomen. She has had a CT scan of head, neck, chest, abdomen and pelvis that has shown left rib fractures and left sided lung infiltrates. There are no other injuries evident. She is receiving oxygen via a Hudson mask, is conscious and has significant left sided pleuritic chest pain.
Discuss the differences in management of this patient compared to a non-obese patient.
The differences in management of this patient compared to a non-obese patient:
A different pattern of injury is to be expected:
Differences in managing the airway of a morbidly obese trauma patient:
Differences in managing the ventilation of a morbidly obese trauma patient:
Difference in managing haemodynamics in a morbidly obese trauma patient:
Difference in managing sedation, analgesia and C-spine protection in the morbidly obese trauma patient
Differences in the investigations
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.