6. Fat Embolism

Question 1

DDx for Fat Embolism

Answer 1

Respiratory
LRTI
PE
Atelectasis
APO
ARDS
Effusion

Cardiac
MI
Failure
Arrhy

Other
Drug
Allergy

Question 2

Fat Embolism Syndrome

Answer 2

Common @ 24-72 h post injury

1 Resp
SOB/ Tachypnoea/ Hypoxia - resp failure like picture
Intubation + MV

2. Petechial rash
   Upper trunk - axilla & Neck
   Buccal membranes
   Conjunctiva
3. Neurological Symptoms
   - Range confusion / drowsy
   Seizure coma
   Focal signs - CN palsy

4. Less common
CVS Compromise
tachycardia
Arryh
Clot abnormal DIC
Renal impairment

Question 3

Prevention & Rx

Answer 3

Early Diagnosis & supportive Rx

Surgical Prevention:

1. Early fracture immobilisation & splinting
2. IM Nail <24h

Reduce trauma complication rate
Balance risk of inducing further embolism
blood loss
length operation

3. Trauma Patients - pulmonary injuries
   temporary ex-fix preferred
   IM Nail when stable
4. Care with IO pressure in surgery

Question 4

Non surgical prevent

Answer 4

Non Surgical Prevention

Prophylactic steroid in risk ??controversial

Supportive
O2 ventilation
hydration
CVS Stability
DVT prop
Care bundle

Rx steroid aspirin heparin ??controversial
Not supported by current evidence

Question 5

What is FES

Answer 5

Rare clinical syndrome of uncertain pathogenesis,
is defined by the presence of
fat globules in the pulmonary circulation.

FES is most commonly associated with long bone (especially femur) and pelvic fractures.

Some cases are associated with trauma in the absence of orthopedic fractures or are nontrauma-related

Question 6

Dx FES

Answer 6

FES is a clinical diagnosis that can be made when the classic triad of hypoxemia, neurologic abnormalities, and the petechial rash occurs in an appropriate clinical setting.