Guide to the emergency management of morbidly obese patients

Abstract

The presence of an acutely ill or injured morbidly obese patient (MOP) in the emergency department (ED) is currently a common occurrence as obesity reaches epidemic proportions internationally. Morbid obesity is defined according to body mass index (BMI), which is equal to weight (kilograms) divided by the square of height (metres).1 The calculated BMI is divided into ranges, with > 25 considered overweight, > 30 obese, > 40 morbidly obese and > 50 super obese. Management of the acutely ill or injured MOP in the ED has a number of peculiarities that must be addressed to ensure adequate, appropriate and effective emergency medical care. The MOP, by virtue of abnormal size, body composition and habitus, deranged physiology and co-morbid disease, has been shown to have an increased morbidity and mortality on admission; this in addition to the effects of the acute medical threat. Besides patient characteristics, the size and weight of the patient may preclude the use of standard-sized beds, diagnostic radiological equipment and other medically required apparatus including effective manpower to provide adequate nursing care.