The Obese Emergency Patient: Imaging Challenges and Solutions

Modica, Michael J.; Kanal, Kalpana M.; Gunn, Martin L.

doi:10.1148/rg.313105138

Cited by 130 publications

(99 citation statements)

References 50 publications

(59 reference statements)

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“…In our study, all of our patients had a body mass index below 30, nevertheless the HI index is a fraction and the needed adjustments of the ultrasound's gain affect equally both parts of this fraction. This minimizes errors in measurement due to excess adipose tissue or pleural thickening (8).…”

Section: Discussionmentioning

confidence: 99%

Correlation of pleural effusions’ grayscale sonographic parameters with fluid’s analysis results

2017

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IntroductionUntil now, in the sonographic imaging of pleural effusions, the quantitative evaluation of the fluids characteristics was performed indirectly by using other anatomic structures of the thorax as a relative measure of comparison (1). Such quantitative methods are used to assess the fluid's volume but to the best of our knowledge no method exists for the measurement of the fluids' density and other qualitative values. The interpretation of the internal echogenicity of a pleural effusion is based upon the subjective observation and evaluation of each operator. According to the internal echogenicity, effusion can be subclassified as anechoic, complex non-septated, complex septated, and homogenously echogenic (2). Additionally, several visual patterns like swirling (3) or sonographic septations (4,5) have been proven useful as diagnostic predictors for pleural effusions (6). We suggest a quantitative method, based on the pixel density of the pleural effusion's image, in order to evaluate the echogenicity of pleural effusion.

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Section: Discussionmentioning

confidence: 99%

Correlation of pleural effusions’ grayscale sonographic parameters with fluid’s analysis results

2017

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“…The table load weight limit indicates the z-axis accuracy as the patient goes through the scanner, ensuring the diagnostic quality of the image. 9 However, if the weight limit is exceeded, the table may bend or break with possible injury to the patient. CT scanners have variable table weight limits, and vendors now offer bariatric tables to accommodate larger patients.…”

Section: Fluoroscopy or Ct?mentioning

confidence: 99%

Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches

Rhyner

Fountain

Chapman

et al. 2017

AJNR Am J Neuroradiol

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SUMMARY:Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career. ABBREVIATIONS:BMI ϭ body mass index; IIH ϭ idiopathic intracranial hypertension; LP ϭ lumbar puncture

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“…43 Because of thick layers of adipose tissue, computed tomography, magnetic resonance imaging, ultrasound, radiography, and even nuclear medicine studies often yield distorted images with limited diagnostic value. 43 These factors can delay or distort data, placing the health care staff in a diagnostic predicament. Adjustments in radiological techniques to acquire better images can also increase exposure to radiation.…”

Section: D: Diagnosticsmentioning

confidence: 99%

“…Adjustments in radiological techniques to acquire better images can also increase exposure to radiation. 43 The scanners commonly used for computed tomography and magnetic resonance imaging have gantry aperture diameter (chest and abdominal girth) restrictions and table load limits. Patients must be able to freely move in and out of the machine's opening during the procedure.…”

Section: D: Diagnosticsmentioning

confidence: 99%

“…However, devices are now available that accommodate patients weighing up to 650 lb (292 kg), but the patient must meet the aperture diameter standards. 43 Nurses should become familiar with the girth and weight restrictions of their facilities' diagnostic equipment. Nurses should also understand hospital protocols for those occasions when patients do not meet criteria for in-house imaging and for alternative imaging locations.…”

Section: D: Diagnosticsmentioning

confidence: 99%

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The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Berrios

2016

Critical Care Nurse

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More than one-third of the US adult population and 17% of the youth are now obese, and obesity is associated with more than $147 billion a year in health care costs. Critical care nurses should understand the physiological differences and practice guidelines for patients with a body mass index greater than 30. The ABCD approach encompasses key clinical concepts in the management of critically ill obese and morbidly obese patients, including management of airways and breathing, minimizing nurses' back and other injuries, increasing awareness of bias, circulation problems, risks of decubitus ulcers and other skin breakdown, differences in drug calculations and metabolism, limitations in diagnostic equipment and imaging, diet and nutritional recommendations, and concerns with durable medical equipment. (Critical Care Nurse. 2016;36[5]:17-26) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Using the ABCD approach, list the key clinical concepts highlighted in this article for managing morbidly obese patients in intensive care units 2. Identify key physiologic differences in airway, breathing, and circulation in morbidly obese patients 3. Identify important considerations in diagnostic and general medical equipment in the management of morbidly obese patients To complete evaluation for CE contact hour(s) for test #C1653, visit www.ccnonline.org and click the "CE Articles" button. No CE test fee for AACN members.

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The Obese Emergency Patient: Imaging Challenges and Solutions

Cited by 130 publications

References 50 publications

Correlation of pleural effusions’ grayscale sonographic parameters with fluid’s analysis results

Correlation of pleural effusions’ grayscale sonographic parameters with fluid’s analysis results

Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

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