Sun28November0440PM 32

Features of fat embolism include:

True / False

Hypoxaemia is uncommon Correct

A petechial rash typically effects the trunk Correct

Fat droplets are identified in the sputum and urine Incorrect answer selected

Pulmonary hypertension may occur Correct

Thrombocytopenia is found in 50% of cases Correct

Explanation

The dispersion of fat droplets into the circulation usually follows major trauma, but it can also occur following the insertion of methylmethacrylate cement during orthopaedic procedures on joints.

A rare fat embolism syndrome has been described that typically occurs several days after long bone fractures. The features include:

Fat embolism syndrome is a clinical diagnosis due to the presence of fat globules in the lung parenchyma and circulation usually after a long bone fracture. Requires high index of suspicion to make the diagnosis.

Typically presents 12-72 hours after initial injury.

Classic triad of:

Respiratory changes: dyspnoea, tachypnoea and hypoxia (early findings). It may progress to respiratory failure and ARDS requiring mechanical ventilation.

Neurological features: cerebral emboli produce neurological signs in up to 86% cases. Often occur after onset of respiratory symptoms. Wide spectrum ranging from mild confusion & drowsiness to seizures. Usually get an acute confusional state with or without focal signs. Most neurological deficits are transient and reversible.

Petechial rash: Is the last component of triad to develop. Occurs in 60% of cases. Rash is seen in the conjunctiva, mucous membranes, skin folds of upper body particularly neck & axilla. Appears in the first 36 hours and resolves in 1 week.

The classic triad is not always present.

May also get - pyrexia, tachycardia, myocardial depression, Right Heart strain on ECG, fluffy retinal exudates, coagulation abnormalities (mimics DIC with hrombocytopenia in 50%) and renal changes (oliguria, lipiduria, proteinuria or haematuria) Biochemical abnormalities also include hypocalcaemia.

The mortality is 5-15%

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