Bariatric Patient Hot Case

GENERAL APPROACH

  • underlying cause of critical illness?
  • specific complications of obesity or bariatric surgery?
  • how does obesity complicate management?

INTRODUCTION

CUBICLE

INFUSIONS

  • insulin infusion (diabetes mellitus)

VENTILATOR

  • VT mL/kg based on predicted body weight not actual body weight
  • high PEEP (improve FRC and compliance, decrease atelectasis)

MONITOR

  • non-invasive BP monitoring (cuff size, accuracy)

EQUIPMENT

  • bariatric equipment (e.g. beds, chairs, hoists)
  • TEDS + IPCs
  • home CPAP device

QUESTION SPECIFIC EXAMINATION

  • often need to examine from both sides of bed
  • may need assistance
  • airway assessment
  • heart failure
  • DVT
  • IV access attempts
  • intertrigo in skin folds and skin care problems

RELEVANT INVESTIGATIONS

  • guided by examination

OPENING STATEMENT

  • “This patient is critically ill due to X. This is complicated by severe obesity causing/ putting them at risk of…”

DISCUSSION

  • obesity paradox
  • obesity bias
  • difficult intubation and IV access in obese patients
  • drug dosing
  • reasons for left and right heart failure in obesity
  • difficulties with diagnosis — examination and investigations

References And Links

LITFL


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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