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【論文摘要】Prioritizing the aspects of an obese patient: An American bariatric ambulance response


Title - Prioritizing the aspects of an obese patient: An American bariatric ambulance response Introduction - Over the last decade, bariatric surgery has quickly grown in the Asia-Pacific region (1). As the percentage of the population with this condition increases so do the considerations for managing the emergency bariatric patient. Many of these patients suffer from mental health problems that exacerbate or contribute to weight gain (2). The following case description I offer as an example from my work as a paramedic in the United States. Case description - My partner and I arrived with the ambulance to find a 45-year-old male 556lbs with chest pain BP 146/92, NSR with polyfocal PVCs rate 92, 12-lead EKG showing no ST elevation, O2 SAT on room air 97%, respiratory rate 24, face flushed, skin warm and dry, complains of chest pain midsternal 5/10 radiating to his back. He is being sent from a freestanding emergency department to a hospital Cardiologist. Prior to my arrival, staff discovered his blood work with negative troponin and positive D-dimer reading but CT scan shows no PE. He already received asprin, oxygen, and morphine. The patient gives off the impression that he is going to do whatever he wants. He says the morphine did not fix his chest pain and he talks so much with so many demands that it is difficult to conduct the regular patient interview without multiple interruptions. The patient is demanding and tells about the other times he has gone by ambulance and the way things are supposed to go, including the exact driving route expected. We begin to push the patient out of the exam room towards the exit and the patient begins yelling to the staff to get him potato chips before he leaves. He tells the staff where the snack closet is located and what brand he wants them to get him. We made it almost to the exit when the patient begins yelling and lunging his body with both arms to grab the candy jar that is on the registration desk. The jar is huge and clear glass, the patient touched it but I was moving fast enough that he was not able to pull it off the counter. It was a close call, the patient almost came off the stretcher and the jar could have broken. Once we were on the ambulance driving to the hospital I asked more about his medical history and he told me he thinks that all of his medical history of obesity, diabetes, and atherosclerosis is related to family genes. He does not refer to himself as "disabled" but instead refers to himself as "retired." Discussion - In situations like this, directly addressing acute medical problems seem to be prioritized over the psychological root problems. Obese patients often think their obesity is related to environmental conditions (3). The result is a patient who forces the prioritization of their personal comforts over the care that they need. Unfortunately, the bariatric patient who is at odds with the treatment plan makes the healthcare team leery about coaching the patient toward lifestyle correction.


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