Emergent Transportation of a Patient Weighing 1000 lbs-a lesson in problem solving

1. Emergent Transportation of a Patient Weighing 1000 lbs-a lesson in problem solving Approximately 65% of adults are overweight and 30% (an estimated 61.3 million) are obese. This number has doubled in the past 20 years. CDC – 2.9 % of the population morbidly obese In a study published in the Archives of Internal Medicine in 1986, one out of every 200 of the population was categorized under super obesity, in 2000 that number was one in 50. Background of the Problem: Obesity Epidemic in the United States Steven W. Powell, MD, MPH New London Hospital (New London, NH) and Dartmouth Hitchcock Medical Center (Lebanon, NH) Setting of the Problem: Case Study Physical Exam (highlights): Gen: Morbidly Obese male in moderate respiratory distress speaking in 3-5 word sentences. Mildly diaphoretic. Vital signs: T 99.9, P 98, RR 26, BP 130/50, O2Sat 75% on RA increasing to 94% on 4L/Min Weight: last known weight 580 lbs • When Bariatric bed arrived, weight recorded as 1016 lbs. • Height: 73 inches • BMI calculates to 134 Pulm: Diminished globally with moderate wheezing noted throughout lung fields Ext: 2+ pedal edema (chronic per pt.) Chronic venous stasis changes Chest X-ray: *Pt. quickly develops Respiratory Arrest* Options to consider for transport: -Local Ambulance - Local Helicopter -Moving Truck -National Guard Blackhawk -Coast Guard Helicopter -Only Available Emergency Transport Vehicle Setting of the Problem: Physical Exam Highlights Preparing the Equipment Moving Patient to the Helicopter Loading Patient in the Helicopter Problem Solving: Transfer Conclusion Successful Transfer Patient discharged in 30 days at a 848lbs Currently down to 650Lbs Jurisdiction/State issues Acknowledgements -Patient for allowing the sharing of his story and the viewing of the pictures -New London Hospital -Dartmouth Hitchcock Medical Center -The United States Army National Guard -The United States Air Force Rescue Center -Multiple local Fire/EMS and Police services Chief Complaint: 32-year-old man with shortness of breath He drove himself to the New London ER on 12/30/08 at 11:30 AM with SOB which had started worsening the night before. He had had upper respiratory symptoms for 3 days Past Medical History:Medications: Asthma Metoprolol 200 mg twice/day Hypertension Aldactone 100 mg twice/day Cellulitis Right leg – 2002 Furosemide 40 mg twice/day Depression Valsartan 320 mg daily Morbid Obesity (BMI >40) Deep Vein Thrombosis Right leg - 2002 Allergies:Family History: Penicillin Mother – 55, thyroid disease Levofloxacin Father – 56, HTN, DM, obesity Brothers – 2, no med. problems No Children Social History: Tobacco: none Alcohol: none Illicits: none Occupation: self-employed as a finish carpenter Lives with his grandmother Single – never married Review of Symptoms (highlights): Gen: distress. Unable to lie back in bed. Has felt feverish with chills. Mild/moderate respiratory HEENT: Slight, clear nasal discharge. Resp: Mild/moderate shortness of breath with productive cough of yellowish/clear sputum. Chronic orthopnea, not specifically worsened currently • Problem Solving : • Emergency Transportation Process