Difference between revisions of "Fat embolism syndrome"

(Sources)
(Background)
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==Background==
 
==Background==
*caused by fat globules in pulmonary microcirculation
+
*Caused by fat globules in pulmonary microcirculation <ref>Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320</ref>
*fat is prothrombotic and pro-inflammatory
+
*Fat is prothrombotic and pro-inflammatory
*commonly associated w orthopedic fractures, esp long bone fractures of lower extremities (eg. femur)
+
*Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities (eg. femur)
*men>women, highest rates: ages 10-40 y/o
+
*Occurance in Men > women, highest rates: ages 10-40 y/o
 +
 
 
==Clinical Features==
 
==Clinical Features==
 
*multi-system dysfunction
 
*multi-system dysfunction

Revision as of 03:23, 30 January 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

  • multi-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

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

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

Sources

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