Difference between revisions of "Fat embolism syndrome"

(edited formatting)
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==Clinical Features==
 
==Clinical Features==
*multi-organ system dysfunction
+
*Multi-organ 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
 
*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver ds, bone marrow harvest/transplant/liposuction
 
*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver ds, bone marrow harvest/transplant/liposuction
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*[[pulmonary embolism]]
+
*[[Pulmonary embolism]]
 
*[[ARDS]]
 
*[[ARDS]]
*[[pulmonary edema]]
+
*[[Pulmonary edema]]
*alveolar hemorrhage
+
*Alveolar hemorrhage
*other causes of [[hypoxemia]
+
*Other causes of [[hypoxemia]
*other causes of [[shock]]
+
*Other causes of [[shock]]
 
 
==Workup==
 
*Clinical diagnosis, no gold standard
 
  
 +
==Diagnosis==
 +
Clinical diagnosis, no gold standard
 
===Gurd's Criteria===  
 
===Gurd's Criteria===  
 
*Most frequently cited diagnostic criteria
 
*Most frequently cited diagnostic criteria
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==Management==
 
==Management==
 +
===Acute Care===
 
*Supportive care
 
*Supportive care
 
*[[Heparin]] and steroids have not shown improvement
 
*[[Heparin]] and steroids have not shown improvement
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*Refractory hypotension/shock: consider ECMO
 
*Refractory hypotension/shock: consider ECMO
  
==Disposition==
+
===Prevention===
*ICU
 
 
 
==Prevention==
 
 
*Decreased incidence with orthopedic repair w/i 24h
 
*Decreased incidence with orthopedic repair w/i 24h
 
*Consider prophylactic corticosteroids in pts w/ long bone fractures
 
*Consider prophylactic corticosteroids in pts w/ long bone fractures
 
**decreased hypoxemia, no difference in mortality
 
**decreased hypoxemia, no difference in mortality
 +
 +
==Disposition==
 +
*ICU
  
 
==See Also==
 
==See Also==
 +
*[[Pulmonary embolism]]
 +
*[[Hypoxemia]]
  
 
==External Links==
 
==External Links==
  
==Sources==
+
==References==
 
<references/>
 
<references/>
  
 
[[Category:Ortho]]
 
[[Category:Ortho]]

Revision as of 20:20, 26 February 2016

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
  • Typically occurs 12-72 hrs after initial insult

Clinical Features

Differential Diagnosis

Diagnosis

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

Acute Care

  • 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

Prevention

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

Disposition

  • ICU

See Also

External Links

References

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