Severe Obesity and the Emergency Department: What You Must Know (ADIEM Sponsored)

In the United States, the rate of obesity is 42%, and the rate of severe obesity is approaching 10%. Individuals with severe obesity make up a significant portion of our ED patient population and there are crucial variations in their chronic physiology, the reg flags for acute critical illness, expected results of ED workup, pharmacotherapy adjustments, airway/breathing intervention recommendations, circulation support considerations, and procedural protocol changes to maximize success and optimize outcomes. Given all these variations and the growing percentage of our population with severe obesity, we as a specialty do not discuss this topic as frequently or thoroughly as we should. There are significant chronic physiologic differences for patients with obesity in terms of airway, breathing, circulation, pharmacokinetics, metabolism, imaging, electrocardiography, and even vital sign variations. This muddies the waters and makes it more difficult for the clinician to identify abnormalities in the critically ill patient with severe obesity. In this session, the speaker will address the most crucial emergency and critical care considerations for patients with obesity, specifically targeting considerations for workup result variations from patients with “normal” body types, as well as nuances in airway/breathing intervention, circulation support, pharmacotherapy adjustments, and possible adjustments to procedural protocols to maximize success. The speaker will also discuss obesity bias in society and medicine, as evidenced by objective data in the most recent literature, and provide a framework for clinicians to identify their own implicit weight bias and mitigate social challenges that come with providing care for patients with severe obesity.

Presenter:

  • Mary E. McLean, MD FACEP FAAEM
Authors

  • Mary E. McLean, MD, FACEP, FAAEM

    AdventHealth East Orlando

    Mary McLean is an Assistant Residency Director for the AdventHealth East Orlando EM Residency Program, and an Adjunct Clinical Associate Professor of Emergency and Internal Medicine for the Lake Erie College of Osteopathic Medicine. She originally hails from Portland, Oregon, and completed her medical education at Oregon Health & Science University School of Medicine and St. John’s Riverside Hospital Emergency Medicine Residency Program. Her professional interests include medical education, research, scholarly activity, public speaking, leadership and advocacy, bias, and diversity, equity, and inclusion. She has spoken nationally and internationally on the medical management of cardiac, neurologic, OB/GYN, neurologic, and traumatic emergencies, as well as on medical education and career development topics. Outside of work, she enjoys documentaries, animals, travel, and being a foodie.

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