1. 1 FAT EMBOLISM SYNDROME(FES)

3. Fat embolism syndrome - a serious manifestation of respiratory, dermatological and neurological symptoms.

4. Most commonly is associated with long bone and pelvic fractures.

5. long bone fractures (1-20 %)

6. More frequent in closed, rather than open fractures.

7. Typically manifests 24 to 72 hours after the initial insult.2

8. 3

9. 4 PATHOPHYSIOLOGY

10. 5

11. Present with a classic triad: hypoxemia; neurologic abnormalities; and a petechial rash Symptoms: High temperature Tachycardia Shortness of breath Restlessness Mild confusion Worst cases: Marked respiratory distress Restlessness Coma Death 6 CLINICAL FEATURES

12. Signs Petechiae : on the head, neck, anterior thorax, subconjunctiva, and axillae. Result from the occlusion of dermal capillaries by fat globules, leading to extravasation of erythrocytes. Hypoxaemia (<8kPa/60 mmHg) is suspicious 7

13. 8 DIAGNOSIS Diagnosis of FES requires at least 1 sign from major criteria and at least 4 signs from the minor criteria

14. 9 SCHONFELD’S SCORING

16. ABG - hypoxia

17. Thrombocytopenia, anemia, and hypofibrinogenemia are indicative of FES, but nonspecific.

18. Urine, blood, sputum examination with Sudan or oil red O staining detect fat globules

19. ECG10 INVESTIGATIONS

21. CXR-diffuse bilateral pulmonary infiltrates

22. Head CT-normal or diffuse white matter petechial hemorrhages

23. Chest CT

24. Parenchymal changes consistent with lung contusion, acute lung injury, or ARDS.

25. Nodular or ground glass opacities in the setting of trauma suggest fat embolism.

26. V/Q scan-normal or subsegmental perfusion defects

27. Procedures

28. BAL-staining of alveolar macrophages for fat11 INVESTIGATIONS

29. 12

31. Stable hemodynamics

32. Blood products as clinically indicated

33. Hydration

34. Prophylaxis of DVT and stress-related gastrointestinal bleeding

35. Nutrition13 TREATMENT

37. Rigid fixation within 24 hours has been shown to make a 5-fold reduction in the incidence of adult respiratory distress syndrome (ARDS).

38. Surgical technique, particularly of reaming or nailing the marrow, may help reduce the volume of fat embolization.

39. Prophylactic placement of inferior vena cava filters may help reduce the volume of fat reaching the heart.