Fat Embolism Syndrome

Question 1

What’s fat embolism? When does it occur? What’s fat embolism syndrome & it’s consequences?

Answer 1

Presence of fat globules within the circulation
May have traumatic or atraumatic aetiologies. Commonly occurs after trauma, occurs in most pts w long bone & pelvic fractures
Most pts have no s&s
FES = rare & potentially fatal consequence of FE, causes a spectrum of end-organ damage, classically the triad of Resp distress, neurological dysfunction & petechial rash

Question 2

What’s the most common ethology of FES?

Answer 2

Blunt force trauma w long bone injury

Question 3

What are some atraumatic causes of FES? Iatrogenic? What proportion of pts have fat globules in circulation after femoral shaft fracture? And during intramedullary reaming for long bone fractures?

Answer 3

Pancreatitis, sickle cell disease, osteomyelitis, DM, fatty liver disease

Extended corticosteroid Rx, liposuction

98%, 88%

Question 4

In which population is FES most common? Why?

Answer 4

Young men, high-velocity trauma more common

Question 5

How soon after long bone injury does FES typically present? Median? What’s the most common symptom of FES? Others?

Answer 5

24-72, 48.5hr. Hypoxia (96%), mental state changes (59%), petechiae (33%)

Question 6

Where are fat emboli typically deposited first? How else may they reach systemic circulation?

Answer 6

Pulm cap bed, causing alveolar dysfunction
AV malf
PFO