Fat embolism syndrome: Difference between revisions
Ostermayer (talk | contribs) |
No edit summary |
||
| Line 9: | Line 9: | ||
*'''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== | ==Workup== | ||
*Clinical diagnosis, no gold standard | |||
===Gurd's Criteria=== | ===Gurd's Criteria=== | ||
*Most frequently cited diagnostic criteria | *Most frequently cited diagnostic criteria | ||
| Line 36: | Line 37: | ||
*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 | ||
| Line 49: | Line 50: | ||
==Management== | ==Management== | ||
*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 | ||
==Disposition== | |||
*ICU | |||
==Prevention== | ==Prevention== | ||
| Line 59: | Line 63: | ||
*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 | ||
==See Also== | ==See Also== | ||
Revision as of 08:40, 31 January 2015
Background
- Caused by fat globules in pulmonary microcirculation [1]
- Fat is prothrombotic and pro-inflammatory
- Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities (eg. femur)
- Occurance in Men > women, highest rates: ages 10-40 y/o
Clinical Features
- multi-system dysfunction
- Classic triad: hypoxemia, neurological abnormalities and petechiae
- neuro findings included: focal deficits, AMS, coma
- thrombocytopenia and anemia common
- can progress to DIC
- Fulminant cases: RV dysfunction, biventricular failure, ARDS, shock, death
- Other etiologies (uncommon): pancreatitis, sickle cell crisis, alcoholic liver ds, bone marrow harvest/transplant/liposuction
Differential Diagnosis
- pulmonary embolism
- ARDS
- pulmonary edema
- alveolar hemorrhage
- other causes of [[hypoxemia]
- other causes of shock
Workup
- Clinical diagnosis, no gold standard
Gurd's Criteria
- Most frequently cited diagnostic criteria
- Need 1 major, 4 minor
Major
- Petechial rash,
- Resp symptoms w XR changes,
- CNS signs unrelated to another condition
Minor
- tachycardia
- pyrexia
- retinal changes (fat or petechiae)
- renal abnormalities (oliguria, anuria or lipiduria)
- thrombocytopenia
- acute anemia
- elevated ESR
- fat globules in sputum
- Chest Xray/CT scan chest
- Bilateral patchy infiltrates
- MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
- Bronchoalveolar lavage
- 30% of alveolar cells staining for fat strongly asso w diagnosis
Management
- Supportive care
- Heparin and steroids have not shown improvement
- Supplemental O2, mechanical ventilation if needed
- Frequent neurochecks, consider ICP monitoring
- Vasopressors as needed
- Refractory hypotension/shock: consider ECMO
Disposition
- ICU
Prevention
- Decreased incidence with orthopedic repair w/i 24h
- Consider prophylactic corticosteroids in pts w/ long bone fractures
- decreased hypoxemia, no difference in mortality
See Also
External Links
Sources
- ↑ Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320