Fat embolism syndrome: Difference between revisions

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==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
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*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
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==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