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Fat Embolism
Last updated 14th May 2021
Presentation
- Manifests clinically as acute respiratory insufficiency – fat globules are present within lung parenchyma or peripheral microcirculation
- Most common after multiple long bone and pelvic fractures
- Triad of
- Pulmonary symptoms (commonest) – dyspnoea, tachypnoea, cyanosis
- Cerebral changes – acute confusion, convulsions, coma
- Dermatological changes – petechial rash, distributed to upper anterior part of body, transient lasting less than 24 hours
- May have a temperature
- Renal – anuria or oliguria
- Retinal signs – retinal haemorrhage, presence of fat droplets
Investigations
- Bloods – FBC (anaemia, thrombocytopenia), U&E, clotting screen, D-dimer
- ECG – may show right heart strain or ischaemia
- CXR – diffuse bilateral pulmonary infiltrates
- CTPA – alternative diagnosis of PE
Management
- Urgent senior help
- No specific drug therapy, supportive treatment – start on oxygen, IV fluids
- Transfer to ITU – may require mechanical ventilation
- Largely preventative measures – early stabilisation of long bone fractures