fat embolism syndrome

Emboli composed of fat are common, relatively innocuous and may occur in alcoholism, BM biopsy, cardiopulmonary bypass, compression injury, DM, lymphangiography, pancreatitis, sickle cell anemia, corticosteroid therapy; contrarily, the FES is neither common nor trivial; clinically significant FE may be endogenous or exogenous in origin; most are due to major fractures, especially of long bones, and trauma to parenchymal organs–eg, the liver–most deaths in the immediate post-trauma period have significant fat embolism, burns, blast injury, severe infections, especially α-toxin-producing Clostridium spp Clinical Hypoxia–50% of femoral shaft fractures have ↓ arterial PO2 within the first few days, acute onset of dyspnea, tachypnea, cyanosis, tachycardia with sudden onset of right-sided cardiac failure, showers of petechiae, thrombocytopenia, cerebral embolism–with changes in personality, confusion, drowsiness, weakness, agitation, spasticity, defects of the visual field, and rarely, extreme pyrexia Diagnosis It had been reported that fat droplets in a BAL was indicative of fat embolism, a finding which in one small–34 group of Pts proved to have a low specificity of 26.5%; > 3% oil red O positive macrophages in the BAL are often found in trauma Pts, and may indicate FES or silent FE Treatment No therapy is effective.

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