 |
|
|
|
 Bookmark Health Information
 Make Health Information Homepage
|
 |
|
Trauma in morbidly obese patient
Differences in the mechanisms of injury
and associated injury patterns have been described, and obesity has been
identified as an independent premorbid risk factor in trauma.
Excessive
weight interferes with activities of daily living, therefore increasing the risk
of injury. Moreover, the presence of obesity-related diseases such as diabetes,
heart disease, and somnolence secondary to sleep apnea may contribute to
accidents.
A higher incidence of displaced ankle and elbow fractures has
been described in obese patients sustaining minimal trauma (stumbling,
low-energy falls). Obese patients have also been noted to be less likely to wear
seat belts because of poor fit or discomfort.
Obesity appears to protect
the blunt trauma victim from head injury, but is associated with a significantly
higher incidence of injuries to the chest, primarily rib fractures and pulmonary
contusions. It is hypothesized that the larger torso serves as a physiologic
airbag, and although this offers some protection from head injury, there is an
associated increase in thoracic injury.
This may partly explain the
dramatically higher mortality rate due to respiratory causes in morbidly obese
trauma patients. The impact of morbid obesity on mortality in blunt trauma was
seen in a study that found a 42.1 percent mortality rate in severely overweight
patients, compared with 5.0 and 8.0 percent in the average and overweight
groups.
Despite the logistical difficulties the obese patient presents,
the principles of trauma management apply, with necessary spinal precautions and
full exposure. The presence of subcutaneous fat obscures physical findings in
thoracic and abdominal injuries. The limitations of physical findings are
further compounded by poor quality portable chest radiographs in this
population. A more aggressive approach to airway management with early
intubation and assisted ventilation may be indicated.
The incidence of
pelvic fractures is higher in the obese trauma victim. Portable films are often
of a poorer quality in the obese patient, therefore clinical suspicion of a
pelvic fracture should be pursued by repeat views or computed tomography,
despite a negative portable pelvic radiograph.
Hit: 671 times
 Print Health Information
Health Home
| |
|
|
|
|
|
Advertise with Draligus.org