Term
| Formula for calculating normal weight for males... |
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Definition
106 lbs. for 1st 5 feet.
Add 6 lbs. for every inch over 5 ft. |
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Term
| Formula for normal weight for women... |
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Definition
100lbs. for 1st 5 ft.
5lbs for every inch over 5 ft. |
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Term
| How do I tell if someone is obese? Morbidly obese? |
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Definition
They weigh 20% more than their predicted normal weight.
Twice predicted weight or 100lbs over predicted weight.
Their weiner heads are found 6 inches deep to the posterior aspect of their overhanging pannus. |
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Term
| In an obese person, CO2 production is ______that of a normal weight person. |
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Definition
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Term
| Obesity is a _______lung disease. |
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Definition
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Term
| What are some respiratory effects of Obesity? |
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Definition
- Decreased reserve (you should pre-oxygenate longer)
- Decreased FRC, lung compliance, VC, IRV, ERV
- Increase work of breathing
- Hypoventilation
- Bronchitis and emphysema are common
- Increased risk of aspiration pneumonitis
- V/Q abnormality leading to shunting
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Term
| Somnolence, twitching, cyanosis, polycythemia, periodic respiration, RVH, RV failure are all symptoms of what disease state associated with obesity? |
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Definition
| Pickwickian syndrome (aka. hypoventilation syndrome) |
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Term
| Rapid fire some CV changes associated with obesity. |
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Definition
- CO twice normal
- HTN
- cardiomegaly
- increased BV (although their EBV is 50-55 cc/Kg)
- CAD and atherosclerosis
- increase risk of thromboemboli
- aortocaval compression (possible)
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Term
T of F: all of the following are true regarding GI changes r/t obesity?
- increased gastric volumes are also more acidic
- Hiatal hernia common
- Fatty liver infiltration, liver dysfunction more common
- poop smells "poopier" than normal
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Definition
| True! (last statement was a hilarious joke) |
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Term
| The airways of "plumpkins" can present challenges for even the most experienced anesthesia provider. List some physical attributes that make it harder to get that tube in. |
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Definition
- high chest wall or breast tissue
- numerous chins
- fleshy cheeks
- large tongue
- enlarged platal, pharyngeal, and supralaryngeal tissue
- prone to soft tissue obstruction (MAC cases)
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Term
| What are some other considerations that make anesthesia more difficult for tubbies? |
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Definition
- High incidence of diabetes
- Difficult IV starts
- Regional is more difficult
- Positioning - prone to nerve injuries especially brachial plexus.
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Term
| What were some other anesthetic considerations (for obese pts) that were randomly thrown on a slide? |
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Definition
- Obtain hx of daily activity, exercise tolerance
- ABGs and PFTs may be necessary
- CXR, EKG, and LFTs should be done
- Determine SaO2 on room air (should be on the chart b/c of implications for post-op discharge...they don't need to go home on a 99% SaO2 if they came in at 91%
- Calculate doses on lean body mass
- Decreased dose requirements for spinal and epidural anesthesia.
- May have difficulty lying supine
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Term
| Is masking an obese patient for an entire case a good idea? |
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Definition
| No. Increased risk of aspiration. Difficult to achieve adequate TVs. |
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Term
| How high should your FiO2 be for super-fatties? |
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Definition
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Term
| Should you deep extubate your chunky monkey patients? |
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Definition
| No! They should be completely awake. |
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Term
| Which is more potent: T3 or T4? |
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Definition
| T3 - it's the primary metabolic regulator. |
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Term
| What metabolic disease is characterized by weight loss, muscle weakness, warm moist skin, heat intolerance, nervousness, hypercalcemia, thrombocytopenia, mild anemia, atrial fibrillation, and dysrhythmias? |
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Definition
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Term
| T or F: Grave's disease is more predominate in males? |
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Definition
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Term
| What thyroid disorder is characterized by an enlarged thyroid gland, exopthalmos, clubbing of the fingers, and occurs more frequently in females? |
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Definition
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Term
| Thyroiditis often follows_______. |
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Definition
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Term
| T or F: thyroiditis is characterized by a firm, painfull gland and is treated with anti-inflammatory agents? |
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Definition
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