The Obese Patient

Obesity has reached epidemic proportions and is increasingly prevalent in the emergency medicine patient population. More than 1 billion adults globally are overweight and at least 300 million of these are clinically obese. Obesity is a complex clinical condition, affecting all organ systems, patient ages, and socioeconomic groups. Obese patients manifest a unique physiology that emergency physicians must recognize and, as a result, appropriately modify their diagnostic and treatment decisions. For example, following trauma, obese patients sustain different injuries and have worse outcomes related to comorbidities. Obese patients with sepsis may require altered doses of antibiotics and special ventilator management. Procedures such as endotracheal intubation, venous access, lumbar puncture, and needle thoracostomy require modifications of technique and equipment. This chapter summarizes the unique pathophysiology of obesity and provides practical suggestions for the diagnosis and treatment of obese patients presenting to the emergency department (ED).