Post-Bariatric Patients: Emergency and Long-Term Care Considerations

In addition, EMS personnel should be aware that added equipment is often required to transport and care for obese patients. For example, an obese individual may have an artificially elevated systolic blood pressure which could be due to an inappropriate fitting blood pressure cuff.  It is necessary to have appropriate sized blood pressure cuffs to ensure that accurate blood pressures are obtained. An inaccurate blood pressure could result in the patient being treated for hypertension when he or she may have a normal pressure. This misdiagnosis in the field while treating the patient could provide adverse results.  In addition, obtaining an accurate weight is important for treating an obese patient once the patient arrives at the hospital. So a scale that has a higher weight limit is a valuable tool. Adequate seating such as larger chairs, carts and wheel chairs should be considered to seat and move these patients safely. Finally, larger gowns should be made available to properly cover these patients, make them feel more comfortable, and honor their dignity.

Case Study: Emergency Personnel Caring for Obese Patients 

EMS responds to a call for a 16 year old, Jerry, who has been having abdominal pain, diarrhea and vomiting. He is brought to the local Emergency Room. While gathering his history the staff finds out he has had gastric bypass surgery. This could impact the differential diagnosis and plan of care.

Health care personnel should keep the following information in mind before inserting an NG tube for a gastric bypass patient:
Placing an NG tube should be carefully considered due to the small stomach pouch which could make the procedure difficult or even result in a perforation. Dumping syndrome frequently occurs with a patient who has had a gastric bypass. Early post-operative complications should be considered with this patient if shortness of breath, tachycardia and/or left shoulder pain is observed. Consider a pulmonary embolism or a gastric suture line leak as a possibility when these symptoms are evident. Also, when presented with these symptoms, the bariatric surgeon caring for the patient or a surgeon familiar with bariatric procedures should be contacted. Their involvement will be critical at this point as a re-operation may be required.

Identifying potential vitamin deficiencies
Vitamin deficiencies and anemia are areas of risk for the obese patient, who may have an inadequate intake of iron rich foods, or may have malabsorption associated with the gastric bypass. This should be top of mind when examining the obese patient. 

Symptoms the patient may present with include: