Fat Embolisation Syndrome
Last modified: 03 December 2021, 5:49:14 PM AEDT
Gems / Priorities1 / 10
- Think embolic destinations for clinical signs
- Lungs = hypoxia
- Brain = confusion
- Skin = petechiae
- Eye = retinal signs
- similar to Bone Cement Syndrome
Epidemiology2 / 10
- Overview
- Incidence
- 3% unilateral
- 33% bilateral long bone fractures
- Prevalence
- Gender
Prognosis3 / 10
- worse prognosis
- PHTN
- AS
- unpredictable prognosis
- unrelated to severity
- mortality 10-20%
Aetiology / Causes / Risk Factors4 / 10
- Patient
- major trauma with long bone fractures
- Anaesthetic
- Surgical
- cemented arthroscopy
- cement is applied under high PRESSURE to bone marrow
- fat is expelled into venous circulation to RIGHT heart
- bone marrow harvest
- liposuction
- cemented arthroscopy
Pathophysiology5 / 10
- may involve dysfunction of pulmonary capillaries
- fat molecules + pneumocytes
- subsequent inflammatory response
Symptoms / History6 / 10
- onset
- 12-48 hours after insult
- classic triad
- Hypoxia
- Neurological abnormalities
- Petechial rash
- only 20-50%, usually conjunctiva, oral mucosa. skin folds
Signs / Examination7 / 10
- RS
- SOB, ⬇SpO2, PHTN, APO, ARDS
- CVS
- ⬆HR, ⬇BP
- NS
- confusion, seizures
- GIT
- Endo
- Haem
- thrombocytopenia 50%
- petechial rash 25-50%
Management8 / 10
- supportive
- RS = intubation / ventilation, treat as ARDS
- CV = HD support and monitoring
- I = corticosteroids
Prevention9 / 10
- Surgical
- early immobilisation of fractures
- operative > traction alone
- limit intraosseous pressure = reduce pressure for cement application
- Drain bone marrow before application
- Anaesthetic
- optimise preload
- ⬆venous tone / pressure
- FiO2 1.0 + vasopressors + IVF + CPR
Anaesthetic considerations10 / 10
- Pre-op
- Intra-op
- Post-op