Blog

Archive for January, 2016

Fat Embolism

Posted on: January 5th, 2016 by admin No Comments

Fat Embolism is a complication of closed fracrures.  It may lead to Respiratory distress, cerebral dysfunction and rash. It is often very difficult to diagnose.

Causes

1. Fractures – closed fractures produce more emboli than open fractures. Long bones pelvis and ribs cause more emboli. Sternum and clavicle furnish less. Multiple fractures produce more emboli.
2. Orthopedic procedures – most commonly intramedullary nailing of the long bones hip or knee replacements.
3. Massive soft tissue injury.
4. Severe burns.
5. Bone marrow biopsy

Non – traumatic settings occasionally lead to fat embolism. These include Conditions associated with:

  1. Liposuction
  2. Fatty liver.
  3. Prolonged corticosteroid therapy
  4. Acute pancreatitis
  5. Osteomyelitis
  6. Conditions causing bone infarcts,especially sickle cell disease.

 

Symptoms

Patients often presents with the following symptoms:

  1. Breathlessness
  2. Chest pain
  3. Fever
  4. Petechial rash
  5. Cerebral dysfunction ( disorientation, confusion, seizures)
  6. Oliguria, haematuria, anuria
  7. Respiratory failure

 

Diagnosis

Major Criteria

  1. Respiratory insufficiency.
  2. Cerebral involvement
  3. Petechial rash

 

Minor Criteria

  1. Tachycardia
  2. Pyrexia ( usually > 39 degrees. C)
  3. Confusion
  4. Sustained pO2,< 8 kPa.
  5. Sustained respiratory rate> 35/minute in spite of sedation.
  6. Retinal changes – cotton wool exudates and small haemorrhages, occasionally fat globules seen in retinal vessels.
  7. Jaundice
  8. Renal signs
  9. Thrombocytopenia
  10. Anaemia
  11. High ESR
  12. Fat macroglobulinemia
  13. Diffuse alveolar infiltrates ‘snow storm apperance’on CXR.

One study concluded that atleast two symptoms for the major criteria Or one symptom for the major criteria must be present to diagnose the Syndrome.

Investigations

–    Chest X-ray
–    Blood gas analysis
–    Blood investigations
–    Urine analysis
–    MRI scan study of Brain
–    Transoesophageal Echocardiogram

Management

–    Sufficient oxygenation
–    Restriction of fluid intake
–    Diuretics
–    Albumin Infusion
–    Mechanical ventilation
–    Heparin anti coagulation

Prevention

–    Early immobilisation of fractures
–    Heparin anti coagulation