Morbidly Obese Patient Flashcards

1
Q

Obesity is defined as

A

WHO:
obese: BMI ≥30 kg/m2
morbidly obese: BMI ≥40 kg/m2

Asia-Pacific Guidlines:
obese: BMI ≥25 kg/m2

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2
Q

Diagnostic criteria for Obesity Hypoventilation Syndrome

A

BMI 30 kg/m2
Daytime PaCO2 >45 mm Hg
Associated sleep-related breathing disorder (OSA-hypopnea syndrome or sleep hypoventilation or both)
Absence of other known causes of hypoventilation

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3
Q

formula for weight estimation based on mid-arm circumference in school-age children

A

weight (kg) = (mid-arm circumference [cm] - 10) x 3

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4
Q

the standard adult blood pressure cuff is too short for patients with an arm circumference of

A

32 cm or larger

Patients who are overweight or obese will require cuffs larger in size

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5
Q

AHA recommendation of cuff widths when evaluating BP in obese

A

arm circuference 35-44 cm: 16 cm width
arm circumference 45-52 cm: 20 cm width
patients with short upper arm length: 16 cm width

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6
Q

Some common drugs that use ideal body weight in dosing

A

pencillins & cephalosporins
corticosteroids & H2-blockers
Digoxin & beta blockers
PROPOFOL
FENTANYL**
**
MIDAZOLAM
& *lorazepam
atracurium, vecuronium
phenytoin
linezolid

**initial dose still based on total body weight*

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7
Q

Some common drugs that use total body weight in dosing

A

ROCURONIUM
ENOXAPARIN
succinylcholine
unfractionated heparin
vancomycin

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8
Q

how to determine ideal body weight by *Devine formula**?

A

male weight = 50 kg + 2.3 kg (each inch >5 feet)

female weight = 45.5 kg + 2.3 kg (each inch >5 feet)

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9
Q

drugs whose initial dose should be based on total body weight but whose subsequent doses should be based on ideal body weight

A

Fentanyl and benzodiazepines
- lipophilic and have a prolonged half-life in obese patietns

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10
Q

remarks on femoral venous catheterization

A

in general, there is an increased incidence of infection and DVT when using the femoral approach.
If this proves to be the only option, then use this site.

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11
Q

remarks on internal jugular venous catheterization

A

the internal jugular vein can be accessed with equal success to the subclavian approach in patietns who are obese

the success rate might be increased with the head maintained in the neutral position, thereby reducing the risk of overlap of the IJV over the carotid artery

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12
Q

remarks on procedural sedation in the obese

A

Give procedural sedation drugs and pain medications cautiously. Select doses at the lower end of the range, and titrate to effect.
Local and regional anesthesia might be considered for complicated or prolonged procedures

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13
Q

characteristics that render obese patients more prone to aspiration during airway management

A
  • increased intra-abdominal pressure
  • increased incidence of hiatal hernia
  • GERD
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14
Q

true or false:
Patients who are obese will desaturate more rapidly after preoxygenation than their lean counterparts.

A

TRUE
When no cervical spine injury is suspected, desaturation may be partially prevented by keeping the patient in a 25-degree head-up position during preoxygenation

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15
Q

maneuver recommended for opening airway in morbidly obese patients

A

Two-person bag-valve mask with a two-handed bilateral jaw thrust is recommended in patients who are morbidly obese.

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16
Q

true or false:
Obesity is a contraindication for rapid-sequence intubation (RSI)

A

FALSE
It is not.
Advance preparation is critical, and assessment for a potential difficult airway is of utmost importance

17
Q

true or false:
The “sniffing” position results in optimal positioning for laryngoscopy in patients who are obese

A

FALSE
“Sniffing” position results in suboptimal view
and this my also confound results and falsely worsen graded views

The “ramping” position offers improved intubation condition in patients who are morbidly obese.
- achieved by placing multiple folded blankets under the upper body, head, and neck until the external auditory meatus and the sternal notch are horizontally aligned

Another option is intubating with the patient semi-upright

18
Q

The relative benefits and risks of the awake intubation approach must be weighed against the merits of RSI, which are:

A
  • reduction of risk of aspiration
  • improved intubating conditions
  • easier insertion of advanced and rescue airway devices
19
Q

Until the proper size tracheostomy tube is located, a _________ ET tube passed through a cricothyroidotomy incision may serve as a temporizing measure

A

6-mm-inner-diameter ET tube

20
Q

with respect to ventilator management, calculate tidal volume using

A

ideal body weight and begin with volumes of 6-8 mL/kg of ideal body weight

21
Q

remarks on trauma in obese patients

A

MORE
rib fractures
pelvic fractures
pulmonary contusions
extremity fractures
risk of death

LESS
head injuries
liver injuries

22
Q

remarks on trauma on mildly overweight patients

A

less prone to intra-abdominal injury because of the protective effect of the abdominal fat, known as “cushion effect”