Fat embolism syndrome - Revision history

ClaireLewis at 00:00, 2 October 2019

2019-10-02T00:00:34Z

← Older revision		Revision as of 00:00, 2 October 2019
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	*Caused by fat globules in pulmonary microcirculation <ref>Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320</ref>		*Caused by fat globules in pulmonary microcirculation <ref>Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320</ref>
	*Fat is prothrombotic and pro-inflammatory		*Fat is prothrombotic and pro-inflammatory
	*Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities (eg. femur)		*Commonly associated with orthopedic [[fractures]], especially long bone fractures of lower extremities (eg. [[femur fracture\|femur]])
	*Occurance in Men > women, highest rates: ages 10-40 y/o		*Occurance in Men > women, highest rates: ages 10-40 y/o
	*Typically occurs 12-72 hrs after initial insult		*Typically occurs 12-72 hrs after initial insult
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	*[[Thrombocytopenia]] and [[anemia]] common		*[[Thrombocytopenia]] and [[anemia]] common
	*Can progress to [[DIC]]		*Can progress to [[DIC]]
	*Fulminant cases: RV dysfunction, biventricular failure, [[ARDS]], [[shock]], death		*Fulminant cases: RV dysfunction, [[heart failure\|biventricular failure]], [[ARDS]], [[shock]], death
	*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver ds, bone marrow harvest/transplant/liposuction		*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver disease, bone marrow harvest/[[bone marrow transplant complications\|transplant]]/liposuction

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[ARDS]]		*[[ARDS]]
	*[[Pulmonary edema]]		*[[Pulmonary edema]]
	*~~Alveolar~~ hemorrhage		*[[Diffuse alveolar hemorrhage]]
	*Other causes of [[hypoxemia]		*Other causes of [[hypoxemia]
	*Other causes of [[shock]]		*Other causes of [[shock]]
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	*Need 1 major, 4 minor		*Need 1 major, 4 minor
	====Major====		====Major====
	*Petechial [[rash]]		*[[petechiae\|Petechial]] [[rash]]
	*~~Resp~~ symptoms ~~w XR~~ changes		*Respiratory symptoms with [[CXR]] changes
	*CNS signs unrelated to another condition		*CNS signs unrelated to another condition
	====Minor====		====Minor====
	*Tachycardia		*[[Tachycardia]]
	*Pyrexia		*[[Hyperthermia\|Pyrexia]]
	*~~retinal~~ changes (fat or petechiae)		*Retinal changes (fat or petechiae)
	*~~renal~~ abnormalities (oliguria, anuria or lipiduria)		*Renal abnormalities (oliguria, anuria or lipiduria)
	*[[~~thrombocytopenia~~]]		*[[Thrombocytopenia]]
	*~~acute~~ [[anemia]]		*Acute [[anemia]]
	*~~elevated~~ ESR		*Elevated ESR
	*~~fat~~ globules in sputum		*Fat globules in sputum

	*~~Chest Xray~~/CT scan chest		*[[CXR]]/CT scan chest
	**Bilateral patchy infiltrates		**Bilateral patchy infiltrates
	*MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI		*[[Brain MRI\|MRI brain]]: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
	*Bronchoalveolar lavage		*Bronchoalveolar lavage
	**30% of alveolar cells staining for fat strongly asso w diagnosis		**30% of alveolar cells staining for fat strongly asso w diagnosis
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	*Supportive care		*Supportive care
	*[[Heparin]] and steroids have not shown improvement		*[[Heparin]] and steroids have not shown improvement
	*Supplemental O2, mechanical ventilation if needed		*Supplemental [[O2]], mechanical ventilation if needed
	*Frequent neurochecks, consider ICP monitoring		*Frequent neurochecks, consider ICP monitoring
	*Vasopressors as needed		*[[Vasopressors]] as needed
	*Refractory hypotension/shock: consider ECMO		*Refractory hypotension/shock: consider [[ECMO]]

	===Prevention===		===Prevention===
	*Decreased incidence with orthopedic repair within 24h		*Decreased incidence with orthopedic repair within 24h
	*Consider prophylactic corticosteroids in patients with long bone fractures		*Consider prophylactic [[corticosteroids]] in patients with long bone fractures
	**Decreased hypoxemia, no difference in mortality		**Decreased hypoxemia, no difference in mortality

Kxl328: /* Prevention */

2018-11-05T18:31:55Z

Prevention

← Older revision		Revision as of 18:31, 5 November 2018
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	*Decreased incidence with orthopedic repair within 24h		*Decreased incidence with orthopedic repair within 24h
	*Consider prophylactic corticosteroids in patients with long bone fractures		*Consider prophylactic corticosteroids in patients with long bone fractures
	**~~decreased~~ hypoxemia, no difference in mortality		**Decreased hypoxemia, no difference in mortality

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "AMS" to "altered mental status"

2016-07-31T05:49:27Z

Text replacement - "AMS" to "altered mental status"

← Older revision		Revision as of 05:49, 31 July 2016
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	*Multi-organ system dysfunction		*Multi-organ system dysfunction
	*'''Classic triad: [[hypoxemia]], neurological abnormalities and petechiae'''		*'''Classic triad: [[hypoxemia]], neurological abnormalities and petechiae'''
	*Neuro findings included: [[focal deficits]], [[~~AMS~~]], [[coma]]		*Neuro findings included: [[focal deficits]], [[altered mental status]], [[coma]]
	*[[Thrombocytopenia]] and [[anemia]] common		*[[Thrombocytopenia]] and [[anemia]] common
	*Can progress to [[DIC]]		*Can progress to [[DIC]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T04:48:13Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:48, 22 July 2016
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	*Other causes of [[shock]]		*Other causes of [[shock]]

	==~~Diagnosis~~==		==Evaluation==
	Clinical diagnosis, no gold standard		Clinical diagnosis, no gold standard
	===Gurd's Criteria===		===Gurd's Criteria===

ClaireLewis: /* Prevention */

2016-07-14T05:03:40Z

Prevention

← Older revision		Revision as of 05:03, 14 July 2016
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	===Prevention===		===Prevention===
	*Decreased incidence with orthopedic repair ~~w/i~~ 24h		*Decreased incidence with orthopedic repair within 24h
	*Consider prophylactic corticosteroids in patients with long bone fractures		*Consider prophylactic corticosteroids in patients with long bone fractures
	**decreased hypoxemia, no difference in mortality		**decreased hypoxemia, no difference in mortality

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T10:59:06Z

Text replacement - " w/ " to " with "

← Older revision		Revision as of 10:59, 12 July 2016
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	===Prevention===		===Prevention===
	*Decreased incidence with orthopedic repair w/i 24h		*Decreased incidence with orthopedic repair w/i 24h
	*Consider prophylactic corticosteroids in patients w/ long bone fractures		*Consider prophylactic corticosteroids in patients with long bone fractures
	**decreased hypoxemia, no difference in mortality		**decreased hypoxemia, no difference in mortality

Neil.m.young: Text replacement - "== " to "=="

2016-07-05T15:40:45Z

Text replacement - "== " to "=="

← Older revision		Revision as of 15:40, 5 July 2016
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	==Diagnosis==		==Diagnosis==
	Clinical diagnosis, no gold standard		Clinical diagnosis, no gold standard
	===Gurd's Criteria===		===Gurd's Criteria===
	*Most frequently cited diagnostic criteria		*Most frequently cited diagnostic criteria
	*Need 1 major, 4 minor		*Need 1 major, 4 minor

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:48:59Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:48, 21 June 2016
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	===Prevention===		===Prevention===
	*Decreased incidence with orthopedic repair w/i 24h		*Decreased incidence with orthopedic repair w/i 24h
	*Consider prophylactic corticosteroids in ~~pts~~ w/ long bone fractures		*Consider prophylactic corticosteroids in patients w/ long bone fractures
	**decreased hypoxemia, no difference in mortality		**decreased hypoxemia, no difference in mortality

Ostermayer: Text replacement - "Category:Ortho" to "Category:Orthopedics"

2016-03-22T15:46:50Z

Text replacement - "Category:Ortho" to "Category:Orthopedics"

← Older revision		Revision as of 15:46, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Ortho~~]]		[[Category:Orthopedics]]

Neil.m.young at 20:20, 26 February 2016

2016-02-26T20:20:05Z

← Older revision		Revision as of 20:20, 26 February 2016
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	==Clinical Features==		==Clinical Features==
	*~~multi~~-organ system dysfunction		*Multi-organ system dysfunction
	*'''Classic triad: [[hypoxemia]], neurological abnormalities and petechiae'''		*'''Classic triad: [[hypoxemia]], neurological abnormalities and petechiae'''
	*~~neuro~~ findings included: [[focal deficits]], [[AMS]], [[coma]]		*Neuro findings included: [[focal deficits]], [[AMS]], [[coma]]
	*[[~~thrombocytopenia~~]] and [[anemia]] common		*[[Thrombocytopenia]] and [[anemia]] common
	*~~can~~ progress to [[DIC]]		*Can progress to [[DIC]]
	*Fulminant cases: RV dysfunction, biventricular failure, [[ARDS]], [[shock]], death		*Fulminant cases: RV dysfunction, biventricular failure, [[ARDS]], [[shock]], death
	*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver ds, bone marrow harvest/transplant/liposuction		*Other etiologies (uncommon): [[pancreatitis]], [[sickle cell crisis]], alcoholic liver ds, bone marrow harvest/transplant/liposuction

	==Differential Diagnosis==		==Differential Diagnosis==
	*[[~~pulmonary~~ embolism]]		*[[Pulmonary embolism]]
	*[[ARDS]]		*[[ARDS]]
	*[[~~pulmonary~~ edema]]		*[[Pulmonary edema]]
	*~~alveolar~~ hemorrhage		*Alveolar hemorrhage
	*~~other~~ causes of [[hypoxemia]		*Other causes of [[hypoxemia]
	*~~other~~ causes of [[shock]]		*Other causes of [[shock]]

	~~==Workup==~~
	*Clinical diagnosis, no gold standard

			==Diagnosis==
			Clinical diagnosis, no gold standard
	===Gurd's Criteria===		===Gurd's Criteria===
	*Most frequently cited diagnostic criteria		*Most frequently cited diagnostic criteria
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	==Management==		==Management==
			===Acute Care===
	*Supportive care		*Supportive care
	*[[Heparin]] and steroids have not shown improvement		*[[Heparin]] and steroids have not shown improvement
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	*Refractory hypotension/shock: consider ECMO		*Refractory hypotension/shock: consider ECMO

	==~~Disposition==~~		===Prevention===
	*ICU

	==~~Prevention~~==
	*Decreased incidence with orthopedic repair w/i 24h		*Decreased incidence with orthopedic repair w/i 24h
	*Consider prophylactic corticosteroids in pts w/ long bone fractures		*Consider prophylactic corticosteroids in pts w/ long bone fractures
	**decreased hypoxemia, no difference in mortality		**decreased hypoxemia, no difference in mortality

			==Disposition==
			*ICU

	==See Also==		==See Also==
			*[[Pulmonary embolism]]
			*[[Hypoxemia]]

	==External Links==		==External Links==

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:Ortho]]		[[Category:Ortho]]