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Managing Pain in Obese ED Patients

Managing Pain in Obese ED Patients

Weight-based dosing of opioids is a commonly used approach for managing patients who present to the ED with more severe pain. “Many patients who present to the ED with pain are obese or morbidly obese,” says Asad E. Patanwala, PharmD. “Heavier patients often receive larger total doses of opioids when compared with normal weight individuals. This can potentially increase the risk of serious adverse events.” He adds that morphine is one of the most commonly used opioids in EDs, but data on morphine dosing are limited among obese individuals. Studies are needed to evaluate the analgesic response to morphine, especially in patients with very high BMIs. Comparing Analgesic Responses In a study published in the Emergency Medicine Journal, Dr. Patanwala and colleagues retrospectively reviewed 300 consecutive patients who received intravenous morphine (4 mg) for pain. Patients were categorized into three groups based on their BMI: non-obese, obese, and morbidly obese. The authors then compared analgesic responses to morphine in the three groups. “Our primary goal was to see if patient weight really matters with regard to analgesic response to morphine,” Dr. Patanwala says. Using a scale of 0 being no pain and 10 being worst possible pain, the median baseline pain scores were 8.5, 8.0, and 8.5 in the non-obese, obese, and morbidly obese groups, respectively. The median analgesic response after morphine administration was 2.0, 3.0, and 2.0 in the non-obese, obese, and morbidly obese groups, respectively. In a linear regression analysis, BMI was not predictive of analgesic response. The analgesic response to a fixed dose of morphine did not appear to change as a function of BMI, says...
Analyzing Why Patients Seek ED Care

Analyzing Why Patients Seek ED Care

According to CDC data, the number of annual visits to EDs across the United States has steadily risen each year. And ED crowding continues to be a significant issue throughout the country due to progressive increases in patient volume. In addition to long wait times and frustration from ED patients, ED crowding has been associated with the risk of poor health outcomes. Several theories have been proposed as to why these trends have persisted over the years. The growing number of medically uninsured people has been identified as a major culprit, but national initiatives like the Affordable Care Act have attempted to curb this issue. Other research suggests that access to care and constraints on provider capacity may serve as important drivers of ED use. Further complicating matters is the nation’s current shortage of primary care providers (PCPs). Measuring Patient Perspectives “Few studies have attempted to measure the perspectives of patients on why they choose the ED to receive their medical care,” says John T. Nagurney, MD, MPH. In a study published in the Journal of Emergency Medicine, Dr. Nagurney, Lana Lobachova, MD, MBA, and other colleagues from Harvard University and Massachusetts General Hospital in Boston sought to measure the distribution and frequency of the reasons why patients chose the ED for their care. In this study, patients presenting to an ED with 92,000 annual visits were surveyed. According to the results, the most common reason patients gave for coming to the ED was their belief that their problem was serious (Table 1). In addition, more than one-third was referred by a healthcare provider. “Only about one-third of patients...
The Unhealthy Habits Kids Take Into Adulthood

The Unhealthy Habits Kids Take Into Adulthood

Meet Jim—the character in this Rewind the Future video—he is a man whose life flashes right before his very eyes, unhealthy habits and all. The choices you teach your child today become the habits they take into their adulthood. Would you show this video to your patients or your patients’ parents? Do you think it would make an impact?   Source: Children’s Healthcare of Atlanta...
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