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Has anyone ever seen this used to rule out PE?  Had a patient in the past with a BMI over 100 so VQ/CT (even bariatic scanner) were not an option. Risk factors, presentation made it a concern on presentation. 

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If there's a high suspicion of PE one might argue for just starting the heparin gtt empirically, unless there's a contraindication. And if there is a contraindication, why would you work it up anyhow? Because there's nothing you could do about it. (thrombectomy? tPA? both very high risk in this patient, I would think)

For inpatients with suspected PE, often we will do a bilateral venous duplex of the lower extremities. If it's positive, then probably a PE. If negative, then less likely.

I too have never had a patient with a BMI that high. Yikes.

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3 minutes ago, mgriffiths said:

During my training in a west TN, we had an acronym to describe these patients, TFTB...Too Fat Too Breath.  Harsh and insensitive, yeah...true, definitely.

I know a doc who puts TFTE on charts. Too fat to evaluate.

cruel, but sometimes true. if you weigh 500 lbs and have abd pain, physical exam and diagnostic studies will be suboptimal.

also LWAB (if anyone asks it's left with antibiotic), but it is his shorthand for "lady was a bitch".

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1 hour ago, mgriffiths said:

During my training in a west TN, we had an acronym to describe these patients, TFTB...Too Fat Too Breath.  Harsh and insensitive, yeah...true, definitely.

Yep, many of these patients just laying them down flat puts them in a mild respiratory distress due to the weight of the chest and sometimes the protuberant abdomen compressing the lungs. And that's without a clot...

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5 hours ago, jennelise said:

Looking back, I guess I was practicing some defensive medicine. She did have risk factors though. 

We all practice defensive med.

At a BMI >100 she has risk factors for everything.  People like this, along with meth abusers, et al, need to be treated with respect, but they are killing themselves and nothing we can do in the ED can stop it.

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10 hours ago, mgriffiths said:

During my training in a west TN, we had an acronym to describe these patients, TFTB...Too Fat Too Breath.  Harsh and insensitive, yeah...true, definitely.

“Body habitus precludes ventilation”

 

Fatelectasis is my personal favorite

Edited by JoeM
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23 hours ago, mgriffiths said:

I have not, but I also have never had a patient with BMI over 100 - I believe the highest I have ever seen was around 65-70.

During my FM rotation, I had a pt with a BMI of 74 who came in for her annual visit. Her BP and labs were perfect, only complaint was knee pain. Then you see people who are in great physical shape but with abnormal labs and health conditions... I don't get it.

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9 minutes ago, vb315 said:

During my FM rotation, I had a pt with a BMI of 74 who came in for her annual visit. Her BP and labs were perfect, only complaint was knee pain. Then you see people who are in great physical shape but with abnormal labs and health conditions... I don't get it.

she probably did not believe that her weight had anything to do with her knee pain....

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Pulmonary angiography can be both diagnostic and therapeutic. Catheter directed tPA is an option as well as various catheters used to retrieve clot.

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On 11/9/2018 at 11:16 AM, vb315 said:

During my FM rotation, I had a pt with a BMI of 74 who came in for her annual visit. Her BP and labs were perfect, only complaint was knee pain. Then you see people who are in great physical shape but with abnormal labs and health conditions... I don't get it.

Back to school you go!!!!!  You obviously missed the lecture detailing the condition "P cubed".😋  Anyone care to assist this poor soul with the definition of the condition stated?  OK, I just finished my first cup of coffee so I'll provide.  Piss poor protoplasm.  😉

Edited by GetMeOuttaThisMess
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12 hours ago, GetMeOuttaThisMess said:

Back to school you go!!!!!  You obviously missed the lecture detailing the condition "P cubed".😋  Anyone care to assist this poor soul with the definition of the condition stated?  OK, I just finished my first cup of coffee so I'll provide.  Piss poor protoplasm.  😉

or the more ominous PB3 (pine box by bedside...)

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