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Principles II- Josh > Obesity PPT and Lecture notes > Flashcards

Obesity PPT and Lecture notes Flashcards

1
Q

what % of aduts are overweight or obese

A

65%

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2
Q

what % of pop are obese

A

30

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3
Q

Mortality is almost ___x’s greater in obese than non-obese

A

4

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4
Q

**** how to calculate IBW (KG)

A

Men- height(cm)-100
women- height (cm)- 105
* 1 inch = 2.54 cm**

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5
Q

calculate IBW for a 6 foot 1 inch man and a 4 foot 11 inch woman

A 
MAN:
6'1"= 73 inches= 182.88cm
182.88cm-100= 82.88kg
82.88kg= 182.336 lbs
Woman:
4'11"=59 inches= 149.86cm
149.86cm-105=44.86kg=98.69lbs
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6
Q

how many cm in an inch??/

A

2.54cm = 1 inch

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7
Q

** how to calculate BMI*

A

Weight (kg)/hgt (M^2)

recorded of kg/m2

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8
Q

how many inches in 1 meter

A

39.4

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9
Q

Calculate BMI for a 6’9” man who weight 300 lbs

A 
ht/m^2
HGT- 6'9'=81 inches x 0.0254=2.0574m
2.0575^2=4.23289476m^2
WGT-300=136.363636363636
BMI=136.36/4.2328947=32.21
BMI=32.21
damn!!!!!!!!
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10
Q 
BMI's
Overweight-
Obese-
extremly Obese-
Super obese-
super super obese-
A 
Overweight- BMI > or = to 25
Obese- BMI > or = to 30
extremly Obese- BMI > or = to 40
Super obese- BMI > or = to 50
super super obese- BMI> or = to 60
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11
Q

morbid obesity is calculated as what?

A

More than twice IBW

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12
Q

A&P of obesity head and neck with problems

A
  • large face and neck=OSA

- thick neck, redundant tissue in airway = difficult intbation

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13
Q

A&P of obesity mobility with problems

A

limited mobility= increased DJD/OA

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14
Q

A&P of obesity stomach with problems

A

full stomach = increased aspiration and GERD

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15
Q

A&P of obesity lungs with problems

A
  • decreased FRC, respiratory compliance and resistance, =increased hypoxemia and atelectasis
  • increased blood volume O2 consumption,CO2 build up = decreased total body water
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16
Q

what does excess body mass do to CV system

A
  • INCREASED metabolic demand and workload
  • INCREASED O2 consumption
  • INCREASED CO2 (chronic),
  • LVH
  • INCREASED SV
  • cardiomegaly
  • HTN
  • CHF
  • INCREASED Pulmonary blood flow and hypoxic pulmonary constriction
  • Pulm HTN,
  • COR pulmonale
  • Right Heart failure
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17
Q

what does excess body mass do to respiratory system in r/t -metabolic need of excess adipose and increased work of breathing

A
  • hypercapnia (CO2 retention)

- hypoxia (O2 consumption)

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18
Q

what does excess body mass do to the pulmonary system r/t restrictive lung disease

A

DECREASED FRC
DECREASED ERV
DECREASED TLC

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19
Q

clinical manifestations of obesity on CV

A 
HTN
cardiomegaly
CHF
CAD
Pulmonary HTN
CO2 increase
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20
Q

CO2 increases by how much for each kg of adipose tissue perfused

A

0.1L/min

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21
Q

clinical manifestations of obesity on Pulmonary system

A 
decreased lung volumes and capacities
arterial hypoxemia
decreased chest wall compliance
OHS-pickwickian syndrome (obesity hypoventilation syndrome)
OSA
22
Q

S/S of pickwickian syndrome (advanced OSA)

A
  • hypercapnia
  • polycythemia
  • right sided heart failure
  • resp acidosis
  • daytime solmnolence
  • hypoventilation
23
Q

clinical manifestations of obesity on liver

A
  • abnormal LFTs
  • fatty liver infiltration
  • cirrhosis
  • hepatomegaly
24
Q

clinical manifestations of obesity on endocrine/metabolic

A 
insulin resistance (DM)
hypercholesterolemia
25
clinical manifestations of obesity on GI system
- hiatal hernia - gastroesophageal reflux - gallstones - pancreatitis
26
clinical manifestations of obesity on Pharmacology are caused by what changes
``` Volume of distribution protein binding lipophilicity increased blood volume decreased total body water increased CO2 ```
27
****what to remember about lipophilic drugs and obesity
- require higher doses (prevent under dosage) | - 1st dose should be by TBW
28
***** ex on lipophilic drugs
propofol fentanyl midazolam succinycholine
29
************** what to remember about water soluble drugs
- require lower dosages (prevent over dosing) | - IBW for initial dose
30
** ex of water soluble drugs
NMBD (VEC and ROC)
31
*********** Down and dirty basics of fat people and drugs***
- --Fat liking drugs love fat people need more | - - water loving drugs hate fat people give less
32
what to remember about SAB and epidural dosages of LA in fat people
doseages are 20-25% lower
33
what should be included in your preop assessment for the fat ones assessment
``` -prior MI HTN Angina PVD exercise tolerance ```
34
what should be included in your preop assessment for the fat ones. things to considerr??
``` CXR ECG PFTs ABGs Vascular access ```
35
what should be included in your preop assessment for the fat ones meds?
home meds | aspiration prophylaxis
36
what should be included in your preop assessment for the fat ones airway exam
TM atlanto-occipital joints LROM narrow airway? redundant tissue?
37
bc they are obese does that mean you'll have a dissicult airway?
nope
38
Anesthesia tech and procedure for the fat ones | preparation
airway equip monitors positioning OR bed
39
Anesthesia tech and procedure for the fat ones. | intraopertive (induction)
- rapid decrease inPaO2 (preoxygenate good) - RSI - awake FOI
40
Anesthesia tech and procedure for the fat ones | Anesthetic tech
- GA - regional (tech difficult) - MAC - Local - extubate fully awake
41
how should fat people be extubated
awake in sitting position
42
Anesthesia tech and procedure for the fat ones | volume replacement
TBW 40% in severly obese (60-65% in normal) - EBV calculated using 45-55ml/kg rather than 70 - avoid rapid rehydration
43
Anesthesia tech and procedure for the fat ones | positioning and skin issues
``` extra padding and skin protection panniculus management (FUPA) ```
44
how is EBV calculated in the obese
45-55 ml/kg
45
Anesthesia tech and procedure for the fat ones | postop
- simi sitting 45 degree - nasal airway - pulse ox - O2/CPAP
46
Anesthesia tech and procedure for the fat ones | pain management
``` Narcs NSAIDS PCA (ALL per IBW) b/c sensitive for respiratory depression ```
47
postop problems associated with obesity
resp failure DVT PE wound infection
48
what to want to prepare for during induction with fat people?
difficult mask ventilation and intubation rapid desaturation airway collapse (poss FOI, sugical airway)
49
what to think about during maintenance with the obese pt r/t positioning
prone, lithotomy, and trend positions need higher FiO2
50
what to watch during maintenance with the obese pt? and how can u correct it
ETCO2 | -give large TV and PEEP
51
what to think about during maintenance with the obese pt r/t emergence
Complete MR reversal | fully awake extubation

Principles II- Josh (17 decks)

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