With regard to fat embolism syndrome (FES), outline the precipitants, clinical features, diagnosis and management
Precipitants:
Trauma-related
Orthopaedic (most common)
Long bone fracture (esp femur)
Pelvic fracture
Elective Orthopaedic surgery
Non-orthopaedic
Liposuction
BM harvest/transplant
Nontrauma-related
Acute pancreatitis
Sickle cell disease
Clinical features
Typically develops 24-72 hours following insult.
Classic clinical triad (neurological, respiratory, cutaneous), none of which is specific for FES.
• Respiratory – the most common presenting feature. Dyspnoea, hypoxia, ARDS
• Neurological – confusion, reduced level of consciousness, seizure, focal deficit, retinal changes (petechiae)
• Petechial rash – usually in non-dependent areas, including neck, axillae, anterior chest, head, subconjunctiva. Only in 1/3 of cases, and often not until 3-5 days after insult.
Other – fever, thrombocytopenia, coagulation abnormalities (incl DIC), anaemia, tachycardia, myocardial depression, renal/liver dysfunction, high ESR
Diagnosis
Based on the clinical features in the setting of known precipitant
CXR may reveal bilateral patchy infiltrates
No single diagnostic test – BAL sampling for lipids has been described – no other tests shown to be useful
Several sets of diagnostic criteria proposed
Management
Prevention clearly preferable if possible – e.g. surgical timing (following fracture) and technique Fixation of fracture
No specific therapy. Supportive only.
Steroids controversial – proposed anti-inflammatory effect but limited data to support
Precipitants
Traumatic | Unrelated to trauma |
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Clinical features
Symptoms of fat embolism
Signs of fat embolism
Diagnosis
Gurd's Criteria Major criteria
Minor criteria
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Lindeque's criteria
Schonfeld criteria
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Laboratory features:
Characteristic imaging:
Management:
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