Fat embolism

Question 1

Two theories pathophys of fat embolism

Answer 1

• Mechanical - fatty tissue directly released into vascular circulation due to trauma
• Biochemical - inflammatory response to trauma causes release of free fatty acids into venous system from bone marrow

Question 2

RF fat embolism

Answer 2

• Young age
• Long bone #
• Closed #
• Multiple #
• Conservative management for long bone#

Question 3

Symptoms of fat embolism

Answer 3

• Present following trauma - within 24-72hrs
• Worsening SOB = main
• Other symptoms - confusion, drowsiness, petechial rash (axilla and conjuctivae)

Question 4

Signs on exam of fat embolism

Answer 4

• Tachypnoeic
• Tachycardia
• Hypoxia
• Acutely confused
• Sometimes low grade pyrexia
• Late stage - organ dysfunction

Question 5

What is criteria to aid diagnosis of fat embolism?

Answer 5

Gurds criteria

Question 6

What is Gurds criteria?

Answer 6

• Presence of 2 major or 1 major + 4 minor criteria = diagnostic
• Major - petechial rash, respiratory insufficiency, cerebral involvement
• Minor - tachycardia, pyrexia, retinal changes, jaundice, low platelets, anaemia, raised ESR, fat macroglobulinaemia

Question 7

Investigatiosn for suspected fat embolism - bedside and bloods

Answer 7

• Routine bloods - FBC, CRP, U&E, LFT, clotting screen
• ABG - type 1 resp failure?
• Blood film - fat globules?

Question 8

Imaging for fat embolism

Answer 8

• CXR - diffuse bilateral pulmonary infiltrates
• CTPA - ground glass changes, global distribution

Question 9

Management fat embolism

Answer 9

• Supportive
• Death usually caused by ARDs following fat embolism
• If severe - mechanical ventilation

Question 10

Preventing fat embolism

Answer 10

• Limiting dispersion of bone marrow into blood stream
• = long bone fractures fixed as early as possible
• If undergoing IM nailling, close monitoring of patients with continous pulse oximetry as are higher risk