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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 obeseIn 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, MPHNew 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/MinWeight: 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 fieldsExt: 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 ConclusionSuccessful TransferPatient 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/dayHypertension Aldactone 100 mg twice/dayCellulitis Right leg – 2002 Furosemide 40 mg twice/dayDepression Valsartan 320 mg dailyMorbid Obesity (BMI >40)Deep Vein Thrombosis Right leg - 2002

Allergies: Family History:Penicillin Mother – 55, thyroid diseaseLevofloxacin Father – 56, HTN, DM, obesity

Brothers – 2, no med. problems No Children

Social History:Tobacco: none Alcohol: none Illicits: noneOccupation: self-employed as a finish carpenterLives with his grandmotherSingle – 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