- Fat embolism
- Usually occurs 24-72 hrs post injury
- Presentation
- Respiratory
- Dyspnoea, Tachypnoea, hypoxia, ARDS
- Neurological
- Confusion, drowsiness, seizures, focal neurology
- Petichial rash
- Usually last to develop, check conjunctiva, Axillary and oral mucosa regions
- Pyrexia, RV strain, coagulation abnormalities
- Associated conditions
- Traumatic
- Long bone #
- Pelvic #
- Ortho procedures
- Burns
- Liposuction
- Non-traumatic
- Pancreatitis
- Osteomyelitis
- Fatty liver
- Bone tumour lysis
- Pathogenesis
- Mechanical
- Supported by echogenic material seen in R heart during ortho surgery
- Doesn't explain why presents at 24-72 hrs
- Biochemical
- Hydrolysis of neutral fat liberates free fatty acids
- Diagnosis
- Major criteria
- Petichiae
- Hypoxia PaO₂ <60mmHg with FiO₂ 0.4
- CNS depression
- Pulmonary oedema
- Minor criteria
- Tachycardia
- Pyrexia
- Retinal emboli
- Fat in urine
- Fat in sputum
- Low Hb/plts
- High ESR
- Treatments
- Maintain oxygenation
- Ventilation if needed
- Stabilise haemodynamics
- Hydration
- DVT prophylaxis
- Stress ulcer prevention
- Immobilise fractures early
- Steroids?, aspirin?
- CEACCP
Link:ceaccp.oxfordjournals.org/content/7/5/148.full.pdf