Bariatric Patients
- Operations for weight loss include a combination of volume restrictive and nutrient malabsorptive procedures that affect satiety, absorption, and insulin sensitivity hormonal or enteric derived factors, in conjunction with behavior modification to achieve and sustain weight loss.
- Patients need a multi-disciplinary team to provide extensive education on nutrition, psychological deterrents, and lifestyle modification.
- Roux-en-y is most common performed bariatric procedure.
- Common complications include marginal ulcers, anastomotic narrowing, obstruction, VTE/PE and internal hernias.
- Management in the ED should include specialized CT protocols and early involvement of patient's surgeons.
Aortic DIssection
- Type A involves the ascending aorta and Type B does not.
- Risk factors involved hypertension, cocaine use, congenital defects, pregnancy, prior heart surgery and prior heat catheterization.
- Most sensitive symptoms include chest pain, “worst pain ever”, and abrupt in onset.
- CXR will commonly show widened mediastinum but can be normal.
- Test of choice is CT angio.
- Treatment in the ED includes rapid vascular consultation, pain relief, and blood pressure control.