Fes

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Fes

  1. 1. 1<br />FAT EMBOLISM SYNDROME(FES) <br />
  2. 2. INTRODUCTION<br /><ul><li>Fat embolism – obstruction by fat embolus, occurring especially after fractures of large bones.
  3. 3. Fat embolism syndrome - a serious manifestation of respiratory, dermatological and neurological symptoms.
  4. 4. Most commonly is associated with long bone and pelvic fractures.
  5. 5. long bone fractures (1-20 %)
  6. 6. More frequent in closed, rather than open fractures.
  7. 7. Typically manifests 24 to 72 hours after the initial insult.</li></ul>2<br />
  8. 8. 3<br />
  9. 9. 4<br />PATHOPHYSIOLOGY<br />
  10. 10. 5<br />
  11. 11. Present with a classic triad: hypoxemia; neurologic abnormalities; and a petechial rash<br />Symptoms: <br />High temperature<br />Tachycardia<br />Shortness of breath<br />Restlessness<br />Mild confusion<br />Worst cases:<br />Marked respiratory distress<br />Restlessness<br />Coma<br />Death<br />6<br />CLINICAL FEATURES<br />
  12. 12. Signs<br />Petechiae : on the head, neck, anterior thorax, subconjunctiva, and axillae.<br />Result from the occlusion of dermal capillaries by fat globules, leading to extravasation of erythrocytes.<br />Hypoxaemia (<8kPa/60 mmHg) is suspicious<br />7<br />
  13. 13. 8<br />DIAGNOSIS<br />Diagnosis of FES requires at least 1 sign from major criteria and at least 4 signs from the minor criteria<br />
  14. 14. 9<br />SCHONFELD’S SCORING<br />
  15. 15. <ul><li>Laboratory
  16. 16. ABG - hypoxia
  17. 17. Thrombocytopenia, anemia, and hypofibrinogenemia are indicative of FES, but nonspecific.
  18. 18. Urine, blood, sputum examination with Sudan or oil red O staining detect fat globules
  19. 19. ECG</li></ul>10<br />INVESTIGATIONS<br />
  20. 20. <ul><li>Imaging
  21. 21. CXR-diffuse bilateral pulmonary infiltrates
  22. 22. Head CT-normal or diffuse white matter petechial hemorrhages
  23. 23. Chest CT
  24. 24. Parenchymal changes consistent with lung contusion, acute lung injury, or ARDS.
  25. 25. Nodular or ground glass opacities in the setting of trauma suggest fat embolism.
  26. 26. V/Q scan-normal or subsegmental perfusion defects
  27. 27. Procedures
  28. 28. BAL-staining of alveolar macrophages for fat</li></ul>11<br />INVESTIGATIONS<br />
  29. 29. 12<br />
  30. 30. Early immobilization of fractures reduces the incidence of FES.<br />Risk is further reduced by operative correction rather than conservative management (ie, traction alone).<br />Supportive care is the mainstay of therapy for clinically apparent FES.<br /><ul><li>Maintenance of adequate oxygenation and ventilation
  31. 31. Stable hemodynamics
  32. 32. Blood products as clinically indicated
  33. 33. Hydration
  34. 34. Prophylaxis of DVT and stress-related gastrointestinal bleeding
  35. 35. Nutrition</li></ul>13<br />TREATMENT<br />
  36. 36. 14<br />SURGICAL CARE<br /><ul><li>Early stabilization of long bone fractures is recommended to minimize bone marrow embolization into the venous system.
  37. 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. 38. Surgical technique, particularly of reaming or nailing the marrow, may help reduce the volume of fat embolization.
  39. 39. Prophylactic placement of inferior vena cava filters may help reduce the volume of fat reaching the heart.</li>

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