Bariatric

Question 1

What is the maximum depth for the Mechanical CPR device?

Answer 1

34cm

Question 2

What is the Braden score and its relevance to bariatric patients?

Answer 2

the Braden score refers to a risk assessment for the development of pressure ulcers.

In terms of bariatric patients they tick all of the risk profiles that look at:
Sensory perception
Moisture
Activity
Mobility
Skin shear
Nutrition

Question 3

When considering mechanisms of injuries in MVC’s, what are some points that are important to remember?

Answer 3

• The amount of weight and force that is transferred through one aspect.
• Extrication of patients needs to be carefully considered.
• Seatbelts are difficult to apply with mobility/flexibility restricted.
• space between chest and steering wheel mean that airbags may not deploy quick enough.

Question 4

What physiological changes may affect your decision to use either IM/IV/IO medications.

Answer 4

IM: insufficient depth of needle may mean you are only injecting into subcutaneous fat.
IV: ability to achieve due to depth of needle and unable to locate landmarks.
IO: inability to find landmarks/depth of needle.

Question 5

Bariatric patients have high risks of developing chronic diseases, what are some of these:

Answer 5

-Type II diabetes
- Hypertension
- Kidney stones
- Psychiatric/depression
- Cardiovascular disease

Question 6

Obese patients have an increased risk of rapid desaturations, what are the reasons for this?

Answer 6

Reduced FRC and increased metabolic demand.

Question 7

What is the considerations for lyophilic drugs and what are the most common ones we are likely be giving?

Answer 7

The risk being that these types of drugs will dissipate into the fatty tissue. Many of these drugs are those that affect the CNS due to the fact that they are a lipophilic profile is required for diffusing across the BBB. Fentanyl, Midazolam, droperidol and ketamine are just a few of these.

Question 8

What considerations should be given when considering CPAP in obese patients?

Answer 8

• CPAP requires a good fit on the mask. A poor mask will result due to the changes in facial shape.

Question 9

Accurate BP is likely difficult to obtain in bariatric patients, what adjustments will you likely use and how will you achieve this?

Answer 9

Auscultations is difficult as is finding a cuff that fits. Alternative sites are important to consider. NIBP may be the only way to obtain usable trends but insufficient to use individual numbers.