QUOTE (CvlSrvnt @ Apr 29 2007, 10:28 AM)

Well...to cut him a little bit of slack, he's hypothyroid, and at least 50 pounds of that was fluid (he hadn't peed in several days, despite 80 a day of Lasix). We couldn't push his limbs close enough together to fit him in the fire department's Stokes Basket - they were rock hard.
But, yeah, I have to agree with you on the rest. Especially since the day before I took a 600 pounder (with decub) out of a second floor apartment, while she screamed about how we all need to learn to accomodate fat people. I'm pretty sure it didn't occur to her that the whole community was "accomodating" her, since she tied up a fire crew and three ambulances for over an hour, leaving the rest of the town virtually without service.
Yeah, but the decreased metabolism of hypothyroid gives somebody only so much of an excuse. For 700lbs, it's really not very much of one.... Of the 1,000 or so charts that I've preloaded into an EMR system so far for the OB/Gyn in my second job, about 980 of the women are being treated for hypothyroid. I'd internally exclaimed at, maybe, the 200 chart mark, that I couldn't believe that so many people in such a small area have the condition. I was amazed!
Wonder how much they'd be able to draw out of him via a straight cath, if anything at all? It's not too surprising, though, to hear that he's anuric at that weight. No matter how much Lasix he'd been getting, if the obesity is disrupting his circulation, with resulting effect on his kidney perfusion, the fluid's not gonna go anywhere.... Sad
Reminds me of a guy that we have in one of the unit's who's got an UGLY abdominal hernia. So ugly that I thought it was a nasty tumor when I first saw him. He's had it for years, apparently, -though it's something that could have easily been corrected by surgery- because his weight is too much for him to be to survive an operation without going into respiratory arrest. And so, he's got this thing the size and weight of a small child hanging off of him. He's also reached the point that his elimination process is starting to fail. He's still got renal perfusion, but he can't use a urinal because his penis is so retracted into his surrounding girth that it can't be isolated and placed into one. Thus both penis and scrot need to be corraled into a hospital water pitcher in order for him to urinate - via 5 to 10 minute concentrated (and digustingly vocal) valsalva manuevering. He, of course, can't hold the pitcher himself, because he can't reach around his stomach from either direction. I won't create any mental pictures for his bed pan use, but, again, it's not a pleasant audible experience for staff and it's not quick. It's questionable just who's suffering is more needless than the other when his call light has to be answered for one of these procedures!
As far as the decub patient (gee, wonder how
that happened?), I doubt it crossed her mind either. From my experience, and as evidenced by her "Serve Me MORE!!!" screaming, such extreme gluttony tends to extend beyond simple food consumption. Again, just Sad....