Sun14November0130PM 3

A 42-year-old woman was involved in a high speed road traffic accident and sustained closed fractures to both femurs and her pelvis. She was admitted as an emergency under the trauma team for surgical reduction and fixation, however there was a delay of 36 hours prior to surgical intervention.

Two days following surgery a medical opinion is sought for shortness of breath and rash.

On examination the patient is tachycardic at 120 bpm, hypoxaemic with a PO2 of 9 kPa on 35% oxygen and pyrexial at 38.5°C. There is evidence of a macular rash which is petechial in nature and has been worsening since the operation.

Blood tests are as follows:

Hb 90 g/L

WCC 12 ×109/L

Plts 98 ×109/L

ESR 86 mm/hr

CRP 95 mg/L

Na 135 mmol/L

K 4.5 mmol/L

Creatinine 135 µmol/L

Which of the follwoing is the unifying diagnosis?

(Please select 1 option)

Thrombotic thrombocytopenic purpura (TTP)

Allergic reaction to medication

Pulmonary embolus

Fat embolism syndrome Correct

Disseminated intravascular coagulopathy (DIC)

Explanation

Fat embolism syndrome is a rare but serious complication of trauma to the pelvis and long bones.

The diagnosis of fat embolism syndrome is predominantly clinical with both major and minor criteria. One major and four minor criteria must be present to make a diagnosis:

Major criteria Minor Criteria

Respiratory symptoms Tachycardia >110 bpm

Petechial rash ESR elevated

Cerebral signs Pyrexial >38.5°C

Radiological disease Fat globules in retina

Acute drop in Hb/platelets

Renal dysfunction

Acute jaundice

The longer the delay between fracture/repair the greater the risk of developing FES. The petechial rash occurs in 20-50 % of patients and is pathognomonic of FES.

Reference:

Medscape. Fat Embolism.

Answer Statistics

1

4%

2

1%

3

2%

4

92%

5

3%

Times answered: 263