Fat embolism syndrome: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Clinical diagnosis, no gold standard | Clinical diagnosis, no gold standard | ||
===Gurd's Criteria=== | ===Gurd's Criteria=== | ||
*Most frequently cited diagnostic criteria | *Most frequently cited diagnostic criteria | ||
*Need 1 major, 4 minor | *Need 1 major, 4 minor |
Revision as of 15:40, 5 July 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
- Multi-organ system dysfunction
- Classic triad: hypoxemia, neurological abnormalities and petechiae
- Neuro findings included: focal deficits, AMS, coma
- Thrombocytopenia and anemia common
- Can progress to DIC
- Fulminant cases: RV dysfunction, biventricular failure, ARDS, shock, death
- Other etiologies (uncommon): pancreatitis, sickle cell crisis, alcoholic liver ds, bone marrow harvest/transplant/liposuction
Differential Diagnosis
- Pulmonary embolism
- ARDS
- Pulmonary edema
- Alveolar hemorrhage
- Other causes of [[hypoxemia]
- Other causes of shock
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 patients w/ long bone fractures
- decreased hypoxemia, no difference in mortality
Disposition
- ICU
See Also
External Links
References
- ↑ Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320