Fat Embolism Syndrome

Question 1

Epidemiology

Answer 1

90% has embolism, about 10micrometer fat globules. but not all develope clinical manifestation (only 4%)

Young adult to mid-adult

1. young: red marrow
2. old: no marrow

Question 2

Etiology

Answer 2

Traumatic causes:
1. Dehydration (hypovolaemic shock, peripheral vasoconstriction leads to centralize blood, more risk of getting fes)

Non traumatic causes:

1. fatty liver
2. acute pancreatitis
3. osteomyelitis

Question 3

Pathology

Answer 3

Mechanical theory:
Release of large droplets into open venosinusoids, deposits in pulmonary beds and microvascular lodging

Biochemical theory:
Lipase secretion in presence of fat emboli, free fatty acids act locally cause increase permeability of pulmonary bed, destruction of alveolar architecture and damage to lung surfactant

Arch of aorta, go to its bracnhes

Question 4

Gurd and Wilson’s diagnostic criteria?

Answer 4

1 major + 4 minor

Question 5

Schonfeld criteria?

Answer 5

score more than 5

Question 6

CF

Answer 6

1. Fever
2. Tachycardia
3. 72 hours up to 10 days
4. Truncal, conjunctival, axillary petechia

Early (Lung)
- SOB

Middle (Brain)
- altered sensorium

Late (Cutaneous)
- petechiae

Question 7

Investigation

Answer 7

1. ABG: Acidosis
2. Anemia, thrombocytopenia, hypofibrinogenemia
   3.

Question 8

X-Ray

Answer 8

Snowstorm appearance

Question 9

Management

Answer 9

1. NS 6 pints (prevent hyoo shock)

Immediate ICU