Difference between revisions of "Fat embolism syndrome"

Line 7: Line 7:
 
==Clinical Features==
 
==Clinical Features==
 
*multi-system dysfunction
 
*multi-system dysfunction
*'''Classic triad: hypoxemia, neurological abnormalities and petechiae'''
+
*'''Classic triad: [[hypoxemia]], neurological abnormalities and [[petechiae]]'''
*neuro findings included: focal deficits, AMS, coma
+
*neuro findings included: [[focal deficits]], [[AMS]], [[coma]]
*[[thrombocytopenia]] and anemia common
+
*[[thrombocytopenia]] and [[anemia]] common
 
*can progress to [[DIC]]
 
*can progress to [[DIC]]
 
*Fulminant cases: RV dysfunction, biventricular failure, [[ARDS]], [[shock]], death
 
*Fulminant cases: RV dysfunction, biventricular failure, [[ARDS]], [[shock]], death
Line 29: Line 29:
 
*Need 1 major, 4 minor
 
*Need 1 major, 4 minor
 
====Major====
 
====Major====
*Petechial rash,
+
*Petechial [[rash]]
*Resp symptoms w XR changes,
+
*Resp symptoms w XR changes
 
*CNS signs unrelated to another condition
 
*CNS signs unrelated to another condition
 
====Minor====
 
====Minor====
*tachycardia
+
*Tachycardia
*pyrexia
+
*Pyrexia
 
*retinal changes (fat or petechiae)
 
*retinal changes (fat or petechiae)
 
*renal abnormalities (oliguria, anuria or lipiduria)
 
*renal abnormalities (oliguria, anuria or lipiduria)
 
*[[thrombocytopenia]]
 
*[[thrombocytopenia]]
*acute anemia
+
*acute [[anemia]]
 
*elevated ESR
 
*elevated ESR
 
*fat globules in sputum
 
*fat globules in sputum
  
 
*Chest Xray/CT scan chest
 
*Chest Xray/CT scan chest
*Bilateral patchy infiltrates
+
**Bilateral patchy infiltrates
 
*MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
 
*MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
 
*Bronchoalveolar lavage
 
*Bronchoalveolar lavage
Line 70: Line 70:
 
==Sources==
 
==Sources==
 
<references/>
 
<references/>
 +
 +
[[Category:Ortho]]

Revision as of 12:06, 4 February 2015

Background

  • Caused by fat globules in pulmonary microcirculation [1]
  • Fat is prothrombotic and pro-inflammatory
  • Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities (eg. femur)
  • Occurance in Men > women, highest rates: ages 10-40 y/o

Clinical Features

Differential Diagnosis

Workup

  • Clinical diagnosis, no gold standard

Gurd's Criteria

  • Most frequently cited diagnostic criteria
  • Need 1 major, 4 minor

Major

  • Petechial rash
  • Resp symptoms w XR changes
  • CNS signs unrelated to another condition

Minor

  • Tachycardia
  • Pyrexia
  • retinal changes (fat or petechiae)
  • renal abnormalities (oliguria, anuria or lipiduria)
  • thrombocytopenia
  • acute anemia
  • elevated ESR
  • fat globules in sputum
  • Chest Xray/CT scan chest
    • Bilateral patchy infiltrates
  • MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
  • Bronchoalveolar lavage
    • 30% of alveolar cells staining for fat strongly asso w diagnosis

Management

  • Supportive care
  • Heparin and steroids have not shown improvement
  • Supplemental O2, mechanical ventilation if needed
  • Frequent neurochecks, consider ICP monitoring
  • Vasopressors as needed
  • Refractory hypotension/shock: consider ECMO

Disposition

  • ICU

Prevention

  • Decreased incidence with orthopedic repair w/i 24h
  • Consider prophylactic corticosteroids in pts w/ long bone fractures
    • decreased hypoxemia, no difference in mortality

See Also

External Links

Sources

  1. Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320