Fat embolism syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *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]] | ||
*[[ | *[[Thrombocytopenia]] and [[anemia]] common | ||
* | *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]] | ||
*[[ARDS]] | *[[ARDS]] | ||
*[[ | *[[Pulmonary edema]] | ||
* | *Alveolar hemorrhage | ||
* | *Other causes of [[hypoxemia] | ||
* | *Other causes of [[shock]] | ||
==Diagnosis== | |||
Clinical diagnosis, no gold standard | |||
===Gurd's Criteria=== | ===Gurd's Criteria=== | ||
*Most frequently cited diagnostic criteria | *Most frequently cited diagnostic criteria | ||
| Line 50: | Line 49: | ||
==Management== | ==Management== | ||
===Acute Care=== | |||
*Supportive care | *Supportive care | ||
*[[Heparin]] and steroids have not shown improvement | *[[Heparin]] and steroids have not shown improvement | ||
| Line 57: | Line 57: | ||
*Refractory hypotension/shock: consider ECMO | *Refractory hypotension/shock: consider ECMO | ||
== | ===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== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 20:20, 26 February 2016
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
- Typically occurs 12-72 hrs after initial insult
Clinical Features
- Multi-organ 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
Diagnosis
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
Acute Care
- 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
Prevention
- Decreased incidence with orthopedic repair w/i 24h
- Consider prophylactic corticosteroids in pts w/ long bone fractures
- decreased hypoxemia, no difference in mortality
Disposition
- ICU
See Also
External Links
References
- ↑ Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320