The problems in the pregnant woman are universal: physiological changes during pregnancy lead to a reduction in time from onset of apnea to oxygen desaturation and to an increased likelihood of regurgitation from a full stomach. An antenatal visit allows the airway to be evaluated and discussion to be held with the parturient about the use of invasive monitors, such as invasive arterial blood pressure monitoring and the use of continuous positive airway pressure devices during and after labor and delivery. A recent development in the management of the airway in the obese patient is the use of the so-called ramped position. Perhaps the main factor responsible for a higher incidence of difficulties in airway management is that general anesthesia is generally reserved for extreme obstetric emergencies. The use of supraglottic airways in the management of the obstetric airway is undergoing evaluation.

Intra-operative positioning considerations are more important for the obese patient. The supine position causes a marked increase in intra-abdominal pressure, which results in a splinting effect of abdominal contents on the diaphragm. Awake, spontaneously breathing obese patients should be in a head-up position. The Trendelenburg position can be used to engorge neck veins to facilitate central venous cannulation. Spontaneously breathing obese patients generally do not tolerate the Trendelenburg position. In mild to moderately obese patients, respiratory mechanics, lung volumes, and oxygenation all increase when changing from the supine to prone position. Due to the difficulties moving and positioning mobidly obese (MO) patients, procedures routinely performed prone are often done in the lateral decubitus position. In the lithotomy position the patient is on their back with their legs and thighs flexed at right angles. MO patients are at special risk for rhabdomyolysis (RML), a potentially fatal post-operative complication.

Abdominal ultrasound has become an extremely useful imaging modality in emergency medicine. Acute appendicitis can be diagnosed with ultrasound and is the preferred initial imaging modality by some clinicians for certain populations, such as in pregnant patients, to avoid ionizing radiation. Ultrasound can be a useful imaging modality for evaluation of abdominal wall hernias, such as ventral wall hernias, incisional hernias, spigelian hernias, femoral hernias, and inguinal hernias. The diseases of the GI tract that can be detected by ultrasound, but may be more appropriately detected by CT scan, are diverticulitis, bowel obstruction, and Crohn disease. Ultrasound imaging of the pancreas is not routinely sought in the ED, but rather more often done on an inpatient or outpatient basis for ultrasound-guided procedures. Ultrasound can be a challenging modality in obese patients and thus has some limitation in the evaluation of various intraabdominal diseases, such as appendicitis.